Effects of Hydroxyethyl Starch Administration on Renal Function in Critically III Patients
Y. Sakr,* D. Payen,† K. Reinhart,* F.S. Sipmann,‡ E. Zavala,§ J. Bewley,∥ G. Marx,* and J.-L. Vincent¶
(Br J Anaesth, 98:216-224, 2007)
*Friedrich-Schiller-University, Jona, Germany; †Centre Hospitalier Universitaire Lariboisiere, Paris, France; ‡Fundación Jiménez Díaz, Madrid, Spain; §Hospital Clinic of Barcelona, Spain; ∥Bristol Royal Infirmary, Bristol, United Kingdom and ¶Erasme Hospital, Free University of Brussels, Belgium on behalf of the `Sepsis Occurrence in Acutely Ill Patients' investigators.
Use of hydroxyethyl starch (HES) solutions has increased because of the high cost of albumin. However, concern exists because of the possible adverse effects of HES, particularly the effect on renal function, which is controversial. This study investigated the effect of HES administration on renal function in 3147 critically ill patients included in a large European database from the Sepsis Occurrence in Acutely Ill Patients study.
All adult patients admitted to the 198 participating intensive care units (ICUs) during a 15-day period were enrolled. Data collected prospectively included daily fluid administration, urine output, sequential organ failure assessment (SOFA) score, serum creatinine levels, and the need for renal replacement therapy (RRT) during the ICU stay. Clinical and laboratory data or the simplified acute physiology II score was reported as the worst value within 24 hours after ICU admission.
Of the 3147 patients included in the Sepsis Occurrence in Acutely Ill Patients study, 1075 received HES during the ICU stay, 932 within 48 hours after admission. The median amount given was 555 mL/d, and the maximum amount was 750 mL/d. Patients who received HES were older, were more likely to be surgically admitted, and had a higher incidence of hematologic malignancy and heart failure; they had higher simplified acute physiology II score and SOFA scores and were less likely to be receiving RRT than those not given HES. The HES group was more likely to receive other colloids. They had a higher incidence of sepsis, severe sepsis, septic shock, and shock as a result of any cause, in addition to greater ICU and hospital mortality rates and longer median ICU and hospital lengths of stay than patients who did not receive HES. The use of colloids varied considerably depending on the country. Serum creatinine levels and daily urine output did not differ regardless of the type of fluid used. The renal SOFA score increased during the ICU stay but was independent of the type of fluid given. Hydroxyethyl starch administration was not associated with an increased risk for subsequent need for RRT, but the presence of sepsis, cardiovascular failure, hematologic cancer, and baseline renal SOFA scores > 1 were risk factors. In patients with severe sepsis and septic shock, HES was not associated with an increased risk for RRT. The investigators concluded that HES did not have an adverse effect on renal function or the need for RRT in the ICU.