Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy
BACKGROUND:Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal...
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| Veröffentlicht in: | Anesthesia and analgesia 2020-10, Vol.131 (4), p.1260-1269 |
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| creator | Lee, Ho-Jin Kwon, Yongsuk Bae, Jinyoung Yoo, Seokha Yoon, Hee-Chul Yoon, Soo-Hyuk Kim, Jin-Tae Bahk, Jae-Hyon Kim, Won Ho |
| description | BACKGROUND:Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal function after nephrectomy.
METHODS:We retrospectively reviewed 1106 patients who underwent partial or radical nephrectomy. The patients were divided into 2 groupspatients who received (HES group) or did not receive 6% HES 130/0.4 intraoperatively (non-HES group). The primary outcome was new-onset chronic kidney disease (CKD) stage 3a (estimated glomerular filtration rate [eGFR] |
| doi_str_mv | 10.1213/ANE.0000000000004926 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1213_ANE_0000000000004926</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>32925347</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4476-d8c86c8cc2d0c1a957e57ff077811e9f13fb55ce62c23d588023d0519989e4af3</originalsourceid><addsrcrecordid>eNqFkU1PAjEQhhujEUT_gTG9eFzox3a3PSIBMSGYiJ43pTvNomWXdJfg_nsLqDEedC6TmXmfSeYdhK4p6VNG-WA4H_fJj4gVS05QlwqWRKlQ8hR1Q5dHTCnVQRd1_RpKSmRyjjqcKSZ4nHaRnba5r95baIrW4UWjvSlwcospJwPSj_GqxBrfaadLAzkeOzCNr1zbAF5UbtusqjAvc_wEpXZ4si3NoTW0DXg8h03hA1Ct20t0ZrWr4eoz99DLZPw8mkazx_uH0XAWmThOkyiXRiZGGsNyYqhWIgWRWkvSVFIKylJul0IYSJhhPBdSkpCIoEpJBbG2vIfi417jq7r2YLONX621bzNKsr1tWbAt-21bwG6O2Ga7XEP-DX35FATyKNhVLpxWv7ntDnxWgHZN8d_u-A_0oBNcRYyw8J0Q0f5rgn8Apa2HbQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy</title><source>MEDLINE</source><source>Journals@Ovid LWW Legacy Archive</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Lee, Ho-Jin ; Kwon, Yongsuk ; Bae, Jinyoung ; Yoo, Seokha ; Yoon, Hee-Chul ; Yoon, Soo-Hyuk ; Kim, Jin-Tae ; Bahk, Jae-Hyon ; Kim, Won Ho</creator><creatorcontrib>Lee, Ho-Jin ; Kwon, Yongsuk ; Bae, Jinyoung ; Yoo, Seokha ; Yoon, Hee-Chul ; Yoon, Soo-Hyuk ; Kim, Jin-Tae ; Bahk, Jae-Hyon ; Kim, Won Ho</creatorcontrib><description>BACKGROUND:Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal function after nephrectomy.
METHODS:We retrospectively reviewed 1106 patients who underwent partial or radical nephrectomy. The patients were divided into 2 groupspatients who received (HES group) or did not receive 6% HES 130/0.4 intraoperatively (non-HES group). The primary outcome was new-onset chronic kidney disease (CKD) stage 3a (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m) or higher or all-cause mortality during 60 months after surgery. Propensity score matching was performed to address baseline differences between the 2 groups. Renal survival determined by stage 3a and stage 5 CKD (eGFR <15 mL/min/1.73 m) or all-cause mortality were compared up to 60 months before and after matching. We compared postoperative acute kidney injury (AKI) and CKD upstaging in the matched cohort as secondary outcomes. Ordinal logistic regression and Cox proportional hazards regression analyses using inverse probability of treatment weighting were performed for postoperative AKI and our primary outcome, respectively. A subgroup analysis of partial nephrectomy was performed.
RESULTS:Thirty percent of patients received HES intraoperatively. Balanced solution and 0.9% normal saline was administered during surgery in both groups. Renal survival was not significantly different between groups after matching (log-rank test P = .377 for our primary outcome, and P = .981 for stage 5 or all-cause mortality, respectively). In the matched cohort (HES groupn = 280, non-HES groupn = 280), the incidence of AKI or CKD upstaging at 1 year was not significantly different (AKIn = 94, 33.6% in HES group versus n = 90, 32.1% in non-HES group; CKD upstagingn = 132, 47.1% in HES group versus n = 122, 43.6% in non-HES group; odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83–1.61; P = .396). Intraoperative HES administration was not associated with postoperative renal outcomes (AKIOR, 0.97; 95% CI, 0.81–1.16; P = .723; CKD stage 3a or higher or all-cause mortalityhazard ratio, 1.01; 95% CI, 0.89–1.14; P = .920). Subgroup analysis yielded similar results.
CONCLUSIONS:Intraoperative 6% HES 130/0.4 administration was not significantly associated with short- and long-term renal function or renal survival up to 5 years in patients undergoing partial or radical nephrectomy. However, wide CI including large harm effect precludes firm conclusion and inadequate assessment of safety cannot be ruled out by our results.</description><identifier>ISSN: 0003-2999</identifier><identifier>EISSN: 1526-7598</identifier><identifier>DOI: 10.1213/ANE.0000000000004926</identifier><identifier>PMID: 32925347</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkin</publisher><subject>Acute Kidney Injury - drug therapy ; Acute Kidney Injury - epidemiology ; Aged ; Cohort Studies ; Female ; Fluid Therapy ; Glomerular Filtration Rate ; Humans ; Hydroxyethyl Starch Derivatives - adverse effects ; Incidence ; Kidney Diseases - chemically induced ; Kidney Diseases - epidemiology ; Kidney Function Tests ; Male ; Middle Aged ; Nephrectomy ; Pharmaceutical Solutions - adverse effects ; Plasma Substitutes - adverse effects ; Postoperative Period ; Propensity Score ; Treatment Outcome</subject><ispartof>Anesthesia and analgesia, 2020-10, Vol.131 (4), p.1260-1269</ispartof><rights>Lippincott Williams & Wilkin</rights><rights>2020 International Anesthesia Research Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4476-d8c86c8cc2d0c1a957e57ff077811e9f13fb55ce62c23d588023d0519989e4af3</citedby><cites>FETCH-LOGICAL-c4476-d8c86c8cc2d0c1a957e57ff077811e9f13fb55ce62c23d588023d0519989e4af3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttp://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=n&CSC=Y&PAGE=fulltext&D=ovft&AN=00000539-202010000-00035$$EHTML$$P50$$Gwolterskluwer$$H</linktohtml><link.rule.ids>314,776,780,4595,27901,27902,65206</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32925347$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lee, Ho-Jin</creatorcontrib><creatorcontrib>Kwon, Yongsuk</creatorcontrib><creatorcontrib>Bae, Jinyoung</creatorcontrib><creatorcontrib>Yoo, Seokha</creatorcontrib><creatorcontrib>Yoon, Hee-Chul</creatorcontrib><creatorcontrib>Yoon, Soo-Hyuk</creatorcontrib><creatorcontrib>Kim, Jin-Tae</creatorcontrib><creatorcontrib>Bahk, Jae-Hyon</creatorcontrib><creatorcontrib>Kim, Won Ho</creatorcontrib><title>Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy</title><title>Anesthesia and analgesia</title><addtitle>Anesth Analg</addtitle><description>BACKGROUND:Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal function after nephrectomy.
METHODS:We retrospectively reviewed 1106 patients who underwent partial or radical nephrectomy. The patients were divided into 2 groupspatients who received (HES group) or did not receive 6% HES 130/0.4 intraoperatively (non-HES group). The primary outcome was new-onset chronic kidney disease (CKD) stage 3a (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m) or higher or all-cause mortality during 60 months after surgery. Propensity score matching was performed to address baseline differences between the 2 groups. Renal survival determined by stage 3a and stage 5 CKD (eGFR <15 mL/min/1.73 m) or all-cause mortality were compared up to 60 months before and after matching. We compared postoperative acute kidney injury (AKI) and CKD upstaging in the matched cohort as secondary outcomes. Ordinal logistic regression and Cox proportional hazards regression analyses using inverse probability of treatment weighting were performed for postoperative AKI and our primary outcome, respectively. A subgroup analysis of partial nephrectomy was performed.
RESULTS:Thirty percent of patients received HES intraoperatively. Balanced solution and 0.9% normal saline was administered during surgery in both groups. Renal survival was not significantly different between groups after matching (log-rank test P = .377 for our primary outcome, and P = .981 for stage 5 or all-cause mortality, respectively). In the matched cohort (HES groupn = 280, non-HES groupn = 280), the incidence of AKI or CKD upstaging at 1 year was not significantly different (AKIn = 94, 33.6% in HES group versus n = 90, 32.1% in non-HES group; CKD upstagingn = 132, 47.1% in HES group versus n = 122, 43.6% in non-HES group; odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83–1.61; P = .396). Intraoperative HES administration was not associated with postoperative renal outcomes (AKIOR, 0.97; 95% CI, 0.81–1.16; P = .723; CKD stage 3a or higher or all-cause mortalityhazard ratio, 1.01; 95% CI, 0.89–1.14; P = .920). Subgroup analysis yielded similar results.
CONCLUSIONS:Intraoperative 6% HES 130/0.4 administration was not significantly associated with short- and long-term renal function or renal survival up to 5 years in patients undergoing partial or radical nephrectomy. However, wide CI including large harm effect precludes firm conclusion and inadequate assessment of safety cannot be ruled out by our results.</description><subject>Acute Kidney Injury - drug therapy</subject><subject>Acute Kidney Injury - epidemiology</subject><subject>Aged</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Fluid Therapy</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Hydroxyethyl Starch Derivatives - adverse effects</subject><subject>Incidence</subject><subject>Kidney Diseases - chemically induced</subject><subject>Kidney Diseases - epidemiology</subject><subject>Kidney Function Tests</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nephrectomy</subject><subject>Pharmaceutical Solutions - adverse effects</subject><subject>Plasma Substitutes - adverse effects</subject><subject>Postoperative Period</subject><subject>Propensity Score</subject><subject>Treatment Outcome</subject><issn>0003-2999</issn><issn>1526-7598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1PAjEQhhujEUT_gTG9eFzox3a3PSIBMSGYiJ43pTvNomWXdJfg_nsLqDEedC6TmXmfSeYdhK4p6VNG-WA4H_fJj4gVS05QlwqWRKlQ8hR1Q5dHTCnVQRd1_RpKSmRyjjqcKSZ4nHaRnba5r95baIrW4UWjvSlwcospJwPSj_GqxBrfaadLAzkeOzCNr1zbAF5UbtusqjAvc_wEpXZ4si3NoTW0DXg8h03hA1Ct20t0ZrWr4eoz99DLZPw8mkazx_uH0XAWmThOkyiXRiZGGsNyYqhWIgWRWkvSVFIKylJul0IYSJhhPBdSkpCIoEpJBbG2vIfi417jq7r2YLONX621bzNKsr1tWbAt-21bwG6O2Ga7XEP-DX35FATyKNhVLpxWv7ntDnxWgHZN8d_u-A_0oBNcRYyw8J0Q0f5rgn8Apa2HbQ</recordid><startdate>20201001</startdate><enddate>20201001</enddate><creator>Lee, Ho-Jin</creator><creator>Kwon, Yongsuk</creator><creator>Bae, Jinyoung</creator><creator>Yoo, Seokha</creator><creator>Yoon, Hee-Chul</creator><creator>Yoon, Soo-Hyuk</creator><creator>Kim, Jin-Tae</creator><creator>Bahk, Jae-Hyon</creator><creator>Kim, Won Ho</creator><general>Lippincott Williams & Wilkin</general><general>International Anesthesia Research Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20201001</creationdate><title>Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy</title><author>Lee, Ho-Jin ; Kwon, Yongsuk ; Bae, Jinyoung ; Yoo, Seokha ; Yoon, Hee-Chul ; Yoon, Soo-Hyuk ; Kim, Jin-Tae ; Bahk, Jae-Hyon ; Kim, Won Ho</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4476-d8c86c8cc2d0c1a957e57ff077811e9f13fb55ce62c23d588023d0519989e4af3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Acute Kidney Injury - drug therapy</topic><topic>Acute Kidney Injury - epidemiology</topic><topic>Aged</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Fluid Therapy</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Hydroxyethyl Starch Derivatives - adverse effects</topic><topic>Incidence</topic><topic>Kidney Diseases - chemically induced</topic><topic>Kidney Diseases - epidemiology</topic><topic>Kidney Function Tests</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nephrectomy</topic><topic>Pharmaceutical Solutions - adverse effects</topic><topic>Plasma Substitutes - adverse effects</topic><topic>Postoperative Period</topic><topic>Propensity Score</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lee, Ho-Jin</creatorcontrib><creatorcontrib>Kwon, Yongsuk</creatorcontrib><creatorcontrib>Bae, Jinyoung</creatorcontrib><creatorcontrib>Yoo, Seokha</creatorcontrib><creatorcontrib>Yoon, Hee-Chul</creatorcontrib><creatorcontrib>Yoon, Soo-Hyuk</creatorcontrib><creatorcontrib>Kim, Jin-Tae</creatorcontrib><creatorcontrib>Bahk, Jae-Hyon</creatorcontrib><creatorcontrib>Kim, Won Ho</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Anesthesia and analgesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lee, Ho-Jin</au><au>Kwon, Yongsuk</au><au>Bae, Jinyoung</au><au>Yoo, Seokha</au><au>Yoon, Hee-Chul</au><au>Yoon, Soo-Hyuk</au><au>Kim, Jin-Tae</au><au>Bahk, Jae-Hyon</au><au>Kim, Won Ho</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy</atitle><jtitle>Anesthesia and analgesia</jtitle><addtitle>Anesth Analg</addtitle><date>2020-10-01</date><risdate>2020</risdate><volume>131</volume><issue>4</issue><spage>1260</spage><epage>1269</epage><pages>1260-1269</pages><issn>0003-2999</issn><eissn>1526-7598</eissn><abstract>BACKGROUND:Although previous studies have reported nephrotoxicity associated with hydroxyethyl starch (HES), the long-term effect of HES on renal function after nephrectomy has rarely been reported. We evaluated the association between intraoperative HES administration and short- and long-term renal function after nephrectomy.
METHODS:We retrospectively reviewed 1106 patients who underwent partial or radical nephrectomy. The patients were divided into 2 groupspatients who received (HES group) or did not receive 6% HES 130/0.4 intraoperatively (non-HES group). The primary outcome was new-onset chronic kidney disease (CKD) stage 3a (estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m) or higher or all-cause mortality during 60 months after surgery. Propensity score matching was performed to address baseline differences between the 2 groups. Renal survival determined by stage 3a and stage 5 CKD (eGFR <15 mL/min/1.73 m) or all-cause mortality were compared up to 60 months before and after matching. We compared postoperative acute kidney injury (AKI) and CKD upstaging in the matched cohort as secondary outcomes. Ordinal logistic regression and Cox proportional hazards regression analyses using inverse probability of treatment weighting were performed for postoperative AKI and our primary outcome, respectively. A subgroup analysis of partial nephrectomy was performed.
RESULTS:Thirty percent of patients received HES intraoperatively. Balanced solution and 0.9% normal saline was administered during surgery in both groups. Renal survival was not significantly different between groups after matching (log-rank test P = .377 for our primary outcome, and P = .981 for stage 5 or all-cause mortality, respectively). In the matched cohort (HES groupn = 280, non-HES groupn = 280), the incidence of AKI or CKD upstaging at 1 year was not significantly different (AKIn = 94, 33.6% in HES group versus n = 90, 32.1% in non-HES group; CKD upstagingn = 132, 47.1% in HES group versus n = 122, 43.6% in non-HES group; odds ratio [OR], 1.16; 95% confidence interval [CI], 0.83–1.61; P = .396). Intraoperative HES administration was not associated with postoperative renal outcomes (AKIOR, 0.97; 95% CI, 0.81–1.16; P = .723; CKD stage 3a or higher or all-cause mortalityhazard ratio, 1.01; 95% CI, 0.89–1.14; P = .920). Subgroup analysis yielded similar results.
CONCLUSIONS:Intraoperative 6% HES 130/0.4 administration was not significantly associated with short- and long-term renal function or renal survival up to 5 years in patients undergoing partial or radical nephrectomy. However, wide CI including large harm effect precludes firm conclusion and inadequate assessment of safety cannot be ruled out by our results.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkin</pub><pmid>32925347</pmid><doi>10.1213/ANE.0000000000004926</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Journals@Ovid LWW Legacy Archive; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Acute Kidney Injury - drug therapy Acute Kidney Injury - epidemiology Aged Cohort Studies Female Fluid Therapy Glomerular Filtration Rate Humans Hydroxyethyl Starch Derivatives - adverse effects Incidence Kidney Diseases - chemically induced Kidney Diseases - epidemiology Kidney Function Tests Male Middle Aged Nephrectomy Pharmaceutical Solutions - adverse effects Plasma Substitutes - adverse effects Postoperative Period Propensity Score Treatment Outcome |
| title | Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution and Renal Function After Nephrectomy |
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