Risk of early postoperative acute kidney injury with stroke volume variation-guided tetrastarch versus Ringer's lactate.
Acute kidney injury
Ringer's lactate
hydroxyethyl starch
tetrastarch
Journal
Saudi journal of anaesthesia
ISSN: 1658-354X
Titre abrégé: Saudi J Anaesth
Pays: India
ID NLM: 101500601
Informations de publication
Date de publication:
Historique:
entrez:
30
1
2019
pubmed:
30
1
2019
medline:
30
1
2019
Statut:
ppublish
Résumé
Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI. Adults scheduled for orthopedic surgery under general anesthesia with >200-300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure. In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) ( SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead.
Sections du résumé
BACKGROUND
BACKGROUND
Whether intraoperative use of hydroxyethyl starch (HES) solutions is associated with postoperative acute kidney injury (AKI) continues to be researched. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is validated for early detection of AKI. Previous studies are limited and use empirically predefined volumes of HES solutions with serum creatinine as marker for AKI.
MATERIALS AND METHODS
METHODS
Adults scheduled for orthopedic surgery under general anesthesia with >200-300 mL blood loss expected were included; 40 were randomized to receive 6% HES 130/0.4 (tetrastarch) (group HES) or Ringer's lactate (group RL) boluses when stroke volume variation (SVV) >10% in supine or lateral position, or >14% in prone position. Incidence of early postoperative AKI using urinary NGAL (>100 ng/mL) was the primary outcome, and using derangement of serum creatinine was the secondary measure.
RESULTS
RESULTS
In 38 patients, intervention was completed, and incidence of AKI (postoperative urinary NGAL >100 ng/mL) among them was 0% in both groups. Patients with urinary NGAL >50 ng/mL were insignificantly higher for group RL versus group HES (6/19 vs. 4/19) (
CONCLUSION
CONCLUSIONS
SVV-guided tetrastarch and Ringer's lactate do not result in postoperative AKI diagnosed by urinary NGAL >100 ng/mL; however, an insignificant trend for better renal functions as well as significantly more efficacious volume expansion and hemodynamic stability were seen with tetrastarch instead.
Identifiants
pubmed: 30692882
doi: 10.4103/sja.SJA_410_18
pii: SJA-13-9
pmc: PMC6329251
doi:
Types de publication
Journal Article
Langues
eng
Pagination
9-15Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
Am J Kidney Dis. 2002 May;39(5):930-6
pubmed: 11979336
Expert Rev Med Devices. 2005 Sep;2(5):523-7
pubmed: 16293062
Anesthesiology. 2006 Sep;105(3):485-91
pubmed: 16931980
Br J Anaesth. 2010 Apr;104(4):407-13
pubmed: 20190260
Nephrol Dial Transplant. 2011 May;26(5):1717-23
pubmed: 21257679
Kidney Int. 2011 Aug;80(4):405-14
pubmed: 21412214
Best Pract Res Clin Anaesthesiol. 2011 Sep;25(3):401-12
pubmed: 21925405
Lancet. 2012 Aug 25;380(9843):756-66
pubmed: 22617274
Crit Care Med. 2013 Feb;41(2):580-637
pubmed: 23353941
Acta Physiol (Oxf). 2013 Apr;207(4):663-72
pubmed: 23375078
Intensive Care Med. 2013 Apr;39(4):558-68
pubmed: 23407978
JAMA. 2013 Feb 20;309(7):678-88
pubmed: 23423413
Intensive Care Med. 2013 May;39(5):811-22
pubmed: 23430019
Lancet. 2013 Jul 13;382(9887):170-9
pubmed: 23727171
Acta Anaesthesiol Belg. 2014;65(1):9-22
pubmed: 24988823
Med Princ Pract. 2014;23(5):413-20
pubmed: 24994571
Anesthesiology. 2014 Nov;121(5):948-58
pubmed: 25127210
Anesth Analg. 2015 Mar;120(3):608-18
pubmed: 25627076
Curr Opin Anaesthesiol. 2015 Jun;28(3):370-7
pubmed: 25887196
Eur J Anaesthesiol. 2016 Jul;33(7):488-521
pubmed: 27043493
Acta Physiol (Oxf). 2017 Mar;219(3):554-572
pubmed: 27474473
BMC Anesthesiol. 2017 Feb 21;17(1):29
pubmed: 28222674