title: Hydroxyethyl Starch 130/0.4 and the Risk of Acute Kidney Injury After Cardiopulmonary Bypass: A Single-Center Retrospective Study.
abstract: OBJECTIVE
  To investigate whether using hydroxyethyl starch (HES) 130/0.4 as a pump prime and for intraoperative fluid therapy is associated with postoperative acute kidney injury (AKI) after adult cardiac surgery.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  University hospital, single center.
  
  
  METHODS
  Six hundred six adult patients who underwent on-pump cardiac surgery between April 2013 and June 2014 were included.
  
  
  METHODS
  Until July 2013, balanced HES 130/0.4 (Volulyte(®), Fresenius Kabi AG, Bad Homburg, Germany) was used both as a pump prime (1,500 mL) and for intraoperative fluid therapy (1,000 mL). From August 2013, HES was replaced entirely by a balanced crystalloid solution (Plasma-Lyte A, Baxter, Lessines, Belgium).
  
  
  RESULTS
  The primary endpoint was the incidence of postoperative AKI during the first 48 postoperative hours, determined using the Acute Kidney Injury Network classification. Secondary outcomes included kidney function at postoperative day 7, postoperative dialysis or hemofiltration, postoperative pulmonary complications, lengths of intensive care unit and hospital stays, postoperative fluid balance and urinary output, surgical revision for bleeding, and 30-day mortality. Multivariable logistic regression was used to adjust for confounders. AKI occurred in 9.5% of crystalloid patients and in 21.5% of HES patients. Patients who received HES were about twice as likely to develop postoperative AKI as those treated with crystalloids (adjusted OR 2.26; 95% CI, 1.40-3.80; p = 0.02). HES patients also had a significantly more positive fluid balance and a lower urinary output during the first 48 postoperative hours. The incidence of surgical revision for bleeding was greater in the HES group (4.6% v 1.4%, p = 0.02).
  
  
  CONCLUSIONS
  This study suggested that using balanced HES 130/0.4 as a pump prime and for intraoperative fluid therapy in adult patients undergoing on-pump cardiac surgery was associated with a greater incidence of AKI during the early postoperative period.
authors.affiliation: Departments of Clinical Perfusion.
authors.forename: Marc-Gilbert
authors.initials: MG
authors.lastname: Lagny
authors.affiliation: Anesthesia and Intensive Care Medicine.
authors.forename: Laurence
authors.initials: L
authors.lastname: Roediger
authors.affiliation: Departments of Clinical Perfusion.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Koch
authors.affiliation: Pharmacy, Liege, Belgium.
authors.forename: Fanny
authors.initials: F
authors.lastname: Dubois
authors.affiliation: Anesthesia and Intensive Care Medicine.
authors.forename: Marc
authors.initials: M
authors.lastname: Senard
authors.affiliation: Public Health, CHU of Liege, Liege, Belgium.
authors.forename: Anne-Françoise
authors.initials: AF
authors.lastname: Donneau
authors.affiliation: Anesthesia and Intensive Care Medicine.
authors.forename: Marie Bernard
authors.initials: MB
authors.lastname: Hubert
authors.affiliation: Anesthesia and Intensive Care Medicine. Electronic address: G.Hans@chu.ulg.ac.be.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hans
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D007430:Intraoperative Care / Q000009:adverse effects / Q000379:methods; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions
keywords: HES; acute kidney injury; cardiac surgery; hydroxyethyl starch