Hydroxyethyl starch and renal dysfunction

Authors: JACOB, LAURENT; HEMING, NICHOLAS; GUIDET, BERTRAND

Source: Transfusion Alternatives in Transfusion Medicine, Volume 9, Number 3, September 2007 , pp. 182-188(7)

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Abstract:

SUMMARY

Large volumes of intravenous fluids may be required to stabilize and maintain hemodynamic stability in several circumstances (kidney transplantation, perioperative period, intensive care). The rationale to use hydroxyethyl starch (HES) 130/0.4 in these patients is to reduce the amounts of fluids infused compared with a pure crystalloid fluid regime. Advantages are a quicker hemodynamic stabilization at comparable volumes and infusion rates, a better practicability, and - theoretically - the avoidance of edema as crystalloids are quickly distributed into the tissue. Clinical experience with HES 130/0.4 in surgical patients, with no difference on renal function compared with patients receiving crystalloids, suggests that HES 130/0.4 is safe for the kidneys. However, in particular in septic patients, the avoidance of a further deterioration of preexisting renal dysfunction is very sensitive. Therefore, patients receiving large amount of HES 130/0.4 should be tightly studied with (i) monitoring of renal function; (ii) ensuring sufficient basic and additional rehydration; and (iii) stopping further administration of HES 130/0.4 once renal dysfunction exceeds a predefined threshold.

Keywords: Colloids; Fluid therapy; Hydroxyethyl starch; Nephrotoxicity; Renal function; Volume replacement

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1778-428X.2007.00075.x

Affiliations: 1: Department of Anesthesiology and Intensive Care, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France;

Publication date: 2007-09-01