title: Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery.
abstract: OBJECTIVE
  This study assessed the effect of 2 types of hydroxyethyl starches (HES) on renal integrity and blood transfusion in cardiac surgery patients.
  
  
  METHODS
  Retrospective investigation.
  
  
  METHODS
  Patients from a single tertiary medical center.
  
  
  METHODS
  Inclusion criteria included coronary artery bypass graft (CABG) and/or valve surgery that included cardiopulmonary bypass with aortic cross-clamping.
  
  
  METHODS
  Intraoperative HES and blood product administration.
  
  
  RESULTS
  The study comprised 1,265 patients who met inclusion criteria. Of these patients, 70% received HES, and of these, 47% received<1,000 mL and 53% received≥1,000 mL. There was no difference in the development of acute kidney injury between the 2 groups. A parsimonious propensity model for colloids showed that combined CABG and valve surgery were less likely to be associated with HES administration than was CABG alone (OR 0.68, confidence interval [CI] 0.46-0.97; p = 0.04). Intra-aortic balloon pump use was less likely to be associated with HES administration (OR 0.57, CI 0.38-0.86; p = 0.007). Patients with chronic kidney disease, stages 3 to 5, were less likely to receive HES, with an OR of 0.56 (CI 0.38-0.84; p = 0.004); 0.51 (CI 0.20-1.33; p = 0.170); and 0.23 (CI 0.12-0.44; p<0.0001), respectively, for each stage. No difference was noted in red blood cell transfusion. However, fresh frozen plasma, cryoprecipitate, and platelet transfusions were significantly higher with larger volumes of HES, with an OR of 2.03 (CI 1.64-2.52; p<0.001); 1.60 (CI 1.30-1.97; p<0.000); and 1.62 (CI 1.21-2.15; p = 0.006), respectively. No differences in surgical mortality were found between the colloid and noncolloid groups.
  
  
  CONCLUSIONS
  This study showed no association of postoperative acute kidney injury and red blood cell transfusion between the colloid and noncolloid groups. Although the complication rate was higher with HES administration, there was no difference in surgery mortality between the 2 groups.
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA.
authors.forename: Rajika
authors.initials: R
authors.lastname: Tobey
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA; Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou Shi, Jiangsu Sheng, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Cheng
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA; Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Gao
authors.affiliation: Department of Internal Medicine University of California Davis Health System, Sacramento, CA.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Surgery, University of California Davis Health System, Sacramento, CA.
authors.forename: J Nilas
authors.initials: JN
authors.lastname: Young
authors.affiliation: Department of Internal Medicine University of California Davis Health System, Sacramento, CA.
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Boyd
authors.affiliation: Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou Shi, Jiangsu Sheng, China.
authors.forename: Fuhai
authors.initials: F
authors.lastname: Ji
authors.affiliation: Department of Anesthesiology and Pain Medicine, University of California Davis Health System, Sacramento, CA. Electronic address: hualiu@ucdavis.edu.
authors.forename: Hong
authors.initials: H
authors.lastname: Liu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003102:Colloids / Q000008:administration & dosage; D017707:Erythrocyte Transfusion / Q000379:methods / Q000639:trends*; D005260:Female; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007430:Intraoperative Care / Q000379:methods / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: acute kidney injury; blood products; cardiopulmonary bypass; hydroxyethyl starch; synthetic colloid