Martin Kieninger1, Daniel Unbekannt2, André Schneiker2, Barbara Sinner2, Sylvia Bele3, Christopher Prasser2. 1. Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. martin.kieninger@ukr.de. 2. Department of Anesthesiology, University Hospital Regensburg, Regensburg, Germany. 3. Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany.
Abstract
BACKGROUND: The application of third-generation hydroxyethyl starch (HES) solutions in critically ill patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) was often part of the treatment of delayed cerebral ischemia (DCI). However, there is increasing evidence showing a correlation between the application of HES and the incidence of acute kidney injury (AKI). METHODS: In a single-center retrospective analysis including 81 patients without a preexisting renal disorder suffering from aSAH who had received higher volumes of 6 % HES 130/0.4 due to standard treatment of DCI, the incidence of AKI during intensive care unit (ICU) stay was recorded using AKIN criteria. Furthermore, the course of serum creatinine after discharge from ICU was observed. RESULTS: 6 % HES 130/0.4 was given over a period of 12.9 ± 7.1 days resulting in a cumulative dose of 12543.2 ± 7743.6 mL. Four patients (4.9 %) fulfilled AKIN criteria stage 1 during ICU stay. In two of these patients, serum creatinine was within normal range again on day of discharge. Five patients showed elevated levels of serum creatinine within 1 to 22 months after hospitalization. A correlation between the amount of HES given and the incidence of AKI could not be found. CONCLUSION: The application of 6 % HES 130/0.4 did not lead to an elevated incidence of AKI in patients without an elevated baseline serum creatinine. However, there is still a lack of high-level evidence as prospective randomized trials are missing yet.
BACKGROUND: The application of third-generation hydroxyethyl starch (HES) solutions in critically ill patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) was often part of the treatment of delayed cerebral ischemia (DCI). However, there is increasing evidence showing a correlation between the application of HES and the incidence of acute kidney injury (AKI). METHODS: In a single-center retrospective analysis including 81 patients without a preexisting renal disorder suffering from aSAH who had received higher volumes of 6 % HES 130/0.4 due to standard treatment of DCI, the incidence of AKI during intensive care unit (ICU) stay was recorded using AKIN criteria. Furthermore, the course of serum creatinine after discharge from ICU was observed. RESULTS: 6 % HES 130/0.4 was given over a period of 12.9 ± 7.1 days resulting in a cumulative dose of 12543.2 ± 7743.6 mL. Four patients (4.9 %) fulfilled AKIN criteria stage 1 during ICU stay. In two of these patients, serum creatinine was within normal range again on day of discharge. Five patients showed elevated levels of serum creatinine within 1 to 22 months after hospitalization. A correlation between the amount of HES given and the incidence of AKI could not be found. CONCLUSION: The application of 6 % HES 130/0.4 did not lead to an elevated incidence of AKI in patients without an elevated baseline serum creatinine. However, there is still a lack of high-level evidence as prospective randomized trials are missing yet.
Authors: E Sander Connolly; Alejandro A Rabinstein; J Ricardo Carhuapoma; Colin P Derdeyn; Jacques Dion; Randall T Higashida; Brian L Hoh; Catherine J Kirkness; Andrew M Naidech; Christopher S Ogilvy; Aman B Patel; B Gregory Thompson; Paul Vespa Journal: Stroke Date: 2012-05-03 Impact factor: 7.914
Authors: Ryan Zarychanski; Ahmed M Abou-Setta; Alexis F Turgeon; Brett L Houston; Lauralyn McIntyre; John C Marshall; Dean A Fergusson Journal: JAMA Date: 2013-02-20 Impact factor: 56.272
Authors: Anders Perner; Nicolai Haase; Per Winkel; Anne B Guttormsen; Jyrki Tenhunen; Gudmundur Klemenzson; Rasmus G Müller; Anders Aneman; Jørn Wetterslev Journal: Intensive Care Med Date: 2014-05-08 Impact factor: 17.440
Authors: John A Myburgh; Simon Finfer; Rinaldo Bellomo; Laurent Billot; Alan Cass; David Gattas; Parisa Glass; Jeffrey Lipman; Bette Liu; Colin McArthur; Shay McGuinness; Dorrilyn Rajbhandari; Colman B Taylor; Steven A R Webb Journal: N Engl J Med Date: 2012-10-17 Impact factor: 91.245
Authors: N J Solenski; E C Haley; N F Kassell; G Kongable; T Germanson; L Truskowski; J C Torner Journal: Crit Care Med Date: 1995-06 Impact factor: 7.598
Authors: Shariq A Khan; Owoicho Adogwa; Tong J Gan; Ulysses T Null; Terence Verla; Sankalp Gokhale; William D White; Gavin W Britz; Ali R Zomorodi; Michael L James; David L McDonagh Journal: Springerplus Date: 2013-07-15
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097