Authors: Tobias Kammerer, M.D. et al
Anesthesiology 1 2018, Vol.128, 67-78.
Background: The use of artificial colloids has declined in critical care, whereas they are still used in perioperative medicine. Little is known about the nephrotoxic potential in noncritically ill patients during routine surgery. The objective of this trial was to evaluate the influences of albumin 5% and balanced hydroxyethyl starch 6% (130/0.4) on renal function and kidney injury.
Methods: One hundred urologic patients undergoing elective cystectomy were randomly assigned for this prospective, single-blinded, controlled study with two parallel groups to receive either albumin 5% or balanced hydroxyethyl starch 6% (130/0.4) as the only perioperative colloid. The primary endpoint was the ratio of serum cystatin C between the last visit at day 90 and the first preoperative visit. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until the third postoperative day and risk, injury, failure, loss, and end-stage renal disease criteria at postoperative days 3 and 90.
Results: The median cystatin C ratio was 1.11 (interquartile range, 1.01 to 1.23) in the albumin and 1.08 (interquartile range, 1.00 to 1.20) in the hydroxyethyl starch group (median difference = 0.03; 95% CI, –0.09 to 0.08; P = 0.165). Also, there were no significant differences concerning serum cystatin C concentrations; estimated glomerular filtration rate; risk, injury, failure, loss, and end-stage renal disease criteria; and neutrophil gelatinase-associated lipocalin. Infusion requirements, transfusion rates, and perioperative hemodynamics were similar in both groups.
Conclusions: With respect to renal function and kidney injury, this study indicates that albumin 5% and balanced hydroxyethyl starch 6% have comparable safety profiles in noncritically ill patients undergoing major surgery.
What We Already Know about This Topic
- Hydroxyethyl starch causes renal injury when given in high doses over prolonged periods to critically ill patients.
- Whether starches cause more renal toxicity than albumin in perioperative patients remains unclear.
What This Article Tells Us That Is New
- One hundred surgical patients were randomly assigned to hydroxyethyl starch (130 kilodaltons) or albumin.
- The primary endpoint was the change in cystatin C on postoperative day 90. Secondary endpoints were estimated glomerular filtration rate and serum neutrophil gelatinase-associated lipocalin until postoperative day 3 and risk, injury, failure, loss, and end-stage renal disease criteria up to postoperative day 90.
- There were no significant differences in any outcome, suggesting that starches do not cause more renal injury than albumin.