title: Impact of balanced tetrastarch raw material on perioperative blood loss: a randomized double blind controlled trial.
abstract: BACKGROUND
  As 6% hydroxyethyl starch (HES) 130/0.40 or 130/0.42 can originate from different vegetable sources, they might have different clinical effects. The purpose of this prospective, randomized, double-blind controlled trial was to compare two balanced tetrastarch solutions, one maize-derived and one potato-derived, on perioperative blood loss in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).
  
  
  METHODS
  We randomly assigned 118 patients undergoing elective cardiac surgery into two groups, to receive either a maize- or a potato-derived HES solution. Study fluids were administered perioperatively (including priming of CPB) until the second postoperative day (POD#2) using a goal directed algorithm. The primary outcome was calculated postoperative blood loss up to POD#2. Secondary outcomes included short-term incidence of acute kidney injury (AKI), and long-term effect (up to one yr) on renal function.
  
  
  RESULTS
  Preoperative and intraoperative characteristics of the subjects were similar between groups. Similar volumes of HES were administered (1950 ml [1250-2325] for maize-HES and 2000 ml [1500-2700] for potato-HES; P=0.204). Calculated blood loss (504 ml [413-672] for maize-HES vs 530 ml [468-705] for potato-HES; P=0.107) and the need for blood components were not different between groups. The incidence of AKI was similar in both groups (P=0.111). Plasma creatinine concentration and glomerular filtration rates did vary over time, although changes were minimal.
  
  
  CONCLUSIONS
  Under our study conditions, HES 130/0.4 or 130/0.42 raw material did not have a significant influence on perioperative blood loss. Moreover, we did not find any effect of tetrastarch raw material composition on short and long-term renal function.
  
  
  BACKGROUND
  EudraCT number: 2011-005920-16.
authors.affiliation: Department of Anesthesiology and Perioperative Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium alexandre.joosten@erasme.ulb.ac.be.
authors.forename: A
authors.initials: A
authors.lastname: Joosten
authors.affiliation: Department of Anesthesiology and Perioperative Care, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Tircoveanu
authors.affiliation: Department of Anesthesiology and Perioperative Care, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Arend
authors.affiliation: Department of Cardiac Surgery, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Wauthy
authors.affiliation: Department of Intensive Care, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Gottignies
authors.affiliation: Department of Anesthesiology and Perioperative Care, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: P
authors.initials: P
authors.lastname: Van der Linden
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D003404:Creatinine
keywords: acute kidney injury; blood loss; cardiac surgical procedures; colloids; hydroxyethyl starch