title: Effect of Hydroxyethyl Starch Solution on Incidence of Acute Kidney Injury in Patients Suffering from Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage.
abstract: The application of third-generation hydroxyethyl starch (HES) solutions in critically ill patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) was often part of the treatment of delayed cerebral ischemia (DCI). However, there is increasing evidence showing a correlation between the application of HES and the incidence of acute kidney injury (AKI).
  
  
  
  In a single-center retrospective analysis including 81 patients without a preexisting renal disorder suffering from aSAH who had received higher volumes of 6 % HES 130/0.4 due to standard treatment of DCI, the incidence of AKI during intensive care unit (ICU) stay was recorded using AKIN criteria. Furthermore, the course of serum creatinine after discharge from ICU was observed.
  
  
  
  6 % HES 130/0.4 was given over a period of 12.9 ± 7.1 days resulting in a cumulative dose of 12543.2 ± 7743.6 mL. Four patients (4.9 %) fulfilled AKIN criteria stage 1 during ICU stay. In two of these patients, serum creatinine was within normal range again on day of discharge. Five patients showed elevated levels of serum creatinine within 1 to 22 months after hospitalization. A correlation between the amount of HES given and the incidence of AKI could not be found.
  
  
  
  The application of 6 % HES 130/0.4 did not lead to an elevated incidence of AKI in patients without an elevated baseline serum creatinine. However, there is still a lack of high-level evidence as prospective randomized trials are missing yet.
authors.affiliation: Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. martin.kieninger@ukr.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kieninger
authors.affiliation: Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Unbekannt
authors.affiliation: Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: André
authors.initials: A
authors.lastname: Schneiker
authors.affiliation: Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sinner
authors.affiliation: Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bele
authors.affiliation: Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Prasser
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000009:adverse effects*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000097:blood / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000097:blood / Q000628:therapy*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D003404:Creatinine
keywords: 6 % HES 103/0.4; Acute kidney injury; Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Delayed cerebral ischemia; Hydroxyethyl starch solution; Neurosurgical intensive care; Serum creatinine