title: Administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury.
abstract: Hydroxyethyl starch (HES) is applied to achieve volume expansion during surgery; however, nephrotoxicity may be induced in patients with sepsis. Simultaneously, neutrophil gelatinase-associated lipocalin (NGAL) and IL-18 have been illustrated as pivotal indicators to diagnose the acute kidney injury (AKI) early. This multi-center, randomized, double-blinded, placebo-controlled study aimed to investigate whether 6% HES 130/0.4 administration caused postoperative AKI, which can be revealed by urinary and plasma NGAL and IL-18 estimations in elderly patients with normal renal function undergoing hip arthroplasty under spinal anesthesia.
  
  
  
  120 ASA I-III, patients aged >65 y undergoing hip arthroplasty under spinal anesthesia randomly received 6% HES 130/0.4 or sodium lactate Ringer's solution 7.5 mL/kg during the first hour of surgery. 118 patients completed the study. Blood pressure, NGAL concentrations, IL18, β2micro-albumin and albumin in urine and creatinine, NGAL and IL-18 in plasma were repeatedly measured before, during, and after surgery.
  
  
  
  The groups were balanced in mean arterial pressure, urine and plasma NGAL, plasma IL-18 and creatinine, urine β2microalbumin and albumin (P > 0.05). Urine IL-18 was dramatically elevated in both groups after surgery (P < 0.05), but did not vary significantly between the groups (P > 0.05).
  
  
  
  Elderly patients undergoing surgery under spinal anesthesia are a high-risk population in AKI. These patients with normal renal function receiving a spinal anesthesia for a short duration surgery would not develop AKI when 500 mL (small volume) HES is infused.
  
  
  
  Identifier: NCT02361736 . Registration date was 2 February 2015.
authors.affiliation: Department of Anaesthesiology, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China.|Tianjin Research Institute of Anaesthesiology, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Anaesthesiology, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China. zyymzkzyy@126.com.|Tianjin Research Institute of Anaesthesiology, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China. zyymzkzyy@126.com.
authors.forename: Yonghao
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Nephron, Tianjin Medical University General Hospital, Anshan Road 154#, Heping District, Tianjin, CN, 300052, People's Republic of China.
authors.forename: Junya
authors.initials: J
authors.lastname: Jia
authors.affiliation: Department of Anaesthesiology, Tianjin First Central Hospital, Fukang Road 24#, Nankai District, Tianjin, CN, 300192, People's Republic of China.
authors.forename: Wenli
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Anaesthesiology, Tianjin First Central Hospital, Fukang Road 24#, Nankai District, Tianjin, CN, 300192, People's Republic of China.
authors.forename: Rubin
authors.initials: R
authors.lastname: Xu
authors.affiliation: Department of Anaesthesiology, Tianjin People's Hospital Tianjin Union Medical Center, Jieyuan Road 190#, Hongqiao District, Tianjin, CN, 300121, People's Republic of China.
authors.forename: Licheng
authors.initials: L
authors.lastname: Geng
authors.affiliation: Department of Anaesthesiology, Tianjin People's Hospital Tianjin Union Medical Center, Jieyuan Road 190#, Hongqiao District, Tianjin, CN, 300121, People's Republic of China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Wei
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced* / Q000175:diagnosis; D000368:Aged; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip; D001794:Blood Pressure; D003404:Creatinine / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D020382:Interleukin-18 / Q000032:analysis; D000071068:Lipocalin-2 / Q000032:analysis; D008297:Male; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012709:Serum Albumin / Q000032:analysis
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D020382:Interleukin-18; D000071068:Lipocalin-2; D010952:Plasma Substitutes; D012709:Serum Albumin; D003404:Creatinine
keywords: Acute kidney injury; Elderly patients; Hydroxyethyl starch; IL-18; NGAL