title: Modern hydroxyethyl starch and acute kidney injury after cardiac surgery: a prospective multicentre cohort.
abstract: BACKGROUND
  Recent trials have shown hydroxyethyl starch (HES) solutions increase the risk of acute kidney injury (AKI) in critically ill patients. It is uncertain whether these adverse effects also affect surgical patients. We sought to determine the renal safety of modern tetrastarch (6% HES 130/0.4) use in cardiac surgical patients.
  
  
  METHODS
  In this multicentre prospective cohort study, 1058 consecutive patients who underwent cardiac surgery from 15th September 2012 to 15th December 2012 were recruited in 23 Spanish hospitals.
  
  
  RESULTS
  We identified 350 patients (33%) administered 6% HES 130/0.4 intraoperatively and postoperatively, and 377 (36%) experienced postoperative AKI (AKI Network criteria). In-hospital death occurred in 45 (4.2%) patients. Patients in the non-HES group had higher Euroscore and more comorbidities including unstable angina, preoperative cardiogenic shock, preoperative intra-aortic balloon pump use, peripheral arterial disease, and pulmonary hypertension. The non-HES group received more intraoperative vasopressors and had longer cardiopulmonary bypass times. After multivariable risk-adjustment, 6% HES 130/0.4 use was not associated with significantly increased risks of AKI (adjusted odds ratio 1.01, 95% CI 0.71-1.46, P=0.91). These results were confirmed by propensity score-matched pairs analyses.
  
  
  CONCLUSIONS
  The intraoperative and postoperative use of modern hydroxyethyl starch 6% HES 130/0.4 was not associated with increased risks of AKI and dialysis after cardiac surgery in our multicentre cohort.
authors.affiliation: Anaesthesia & Intensive Care, Hospital Universitari Bellvitge, Universitat de Barcelona, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907, Spain marcvives50@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Vives
authors.affiliation: Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Callejas
authors.affiliation: Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Duque
authors.affiliation: Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Echarri
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Toronto, ON, Canada.|Department of Anesthesia and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada.
authors.forename: D N
authors.initials: DN
authors.lastname: Wijeysundera
authors.affiliation: Department of Anesthesiology and Critical Care, University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: Department of Anesthesiology and Critical Care, Bellvitge University Hospital, C/ Feixa Llarga, s/n. Hospitalet, Barcelona 08907, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Sabate
authors.affiliation: Department Preventive Medicine and Public Health, University of Navarra, Av. Pio XII, 36, 31008 Pamplona, Spain.|CIBERobn, Instituto de Salud Carlos III, Spain.|IDISNA, Navarra's Health Research Institute, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Bes-Rastrollo
authors.affiliation: Anesthesiology & Critical Care, Clinica Universidad de Navarra, Avenida Pio 12, 36, 31008 Pamplona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Monedero
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017582:Renal Replacement Therapy
chemical_list: D006895:Hydroxyethyl Starch Derivatives
keywords: acute kidney injury; cardiac surgery; hydroxyethyl starch; patient outcomes; renal replacement therapy