Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis
Background We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial. Metho...
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| Veröffentlicht in: | Acta anaesthesiologica Scandinavica 2015-03, Vol.59 (3), p.329-336 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | MÜLLER, R. B. HAASE, N. LANGE, T. WETTERSLEV, J. PERNER, A. |
| description | Background
We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial.
Methods
In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury (AKI) in the HES vs. Ringer's acetate groups using the Kidney Disease: Improving Global Outcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy (RRT).
Results
At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. Ringer's group within the first 5 days after randomisation (P = 0.03), the average difference being 0.2 points (P |
| doi_str_mv | 10.1111/aas.12453 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1897386785</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1897386785</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4943-171b687a46e9e2c04bcdb459995785a186607c1518e8d14d6c761369bad94b483</originalsourceid><addsrcrecordid>eNqFkU1P4zAQhi20CErZA39gFWkvyyGtJ_6KjxVavj8ELOJoOc6gpqRNsRMg_x5DgQPSCl9Glp55NDMvITtARxDf2NowgowLtkYGwLROpVDyBxlQSiEVoLJNshXCLH4Z13qDbGZCZDxnMCD7E9e1mNxX5QL7pFrMOt8nT1U7TaZ96ZvnHttpXyehtd5NE2B0TEc8i2AS8BE9xrIMVdgm63e2DvjzvQ7Jzf7ff3uH6enFwdHe5DR1XHOWgoJC5spyiRozR3nhyoILrbVQubCQS0mVAwE55iXwUjolgUld2FLzIk48JH9W3qVvHjoMrZlXwWFd2wU2XTCQa8VyGWXfozIeQSgd5xqS31_QWdP5RVzkleIKBGcQqd0V5XwTgsc7s_TV3PreADWvOZiYg3nLIbK_3o1dMcfyk_w4fATGK-CpqrH_v8lMJtcfynTVUYUWnz87rL83UjElzO35gTnXV7fi-OTSnLEXUiucxw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1654715431</pqid></control><display><type>article</type><title>Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis</title><source>MEDLINE</source><source>Wiley Journals</source><creator>MÜLLER, R. B. ; HAASE, N. ; LANGE, T. ; WETTERSLEV, J. ; PERNER, A.</creator><creatorcontrib>MÜLLER, R. B. ; HAASE, N. ; LANGE, T. ; WETTERSLEV, J. ; PERNER, A.</creatorcontrib><description>Background
We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial.
Methods
In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury (AKI) in the HES vs. Ringer's acetate groups using the Kidney Disease: Improving Global Outcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy (RRT).
Results
At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. Ringer's group within the first 5 days after randomisation (P = 0.03), the average difference being 0.2 points (P < 0.01). An increase in AKI stage was associated with mortality (hazard ratio (HR) 1.35; 95% CI 1.22 to 1.49; P < 0.01). Significantly, more patients in the HES group received RRT within the first 5 days (P = 0.01), and the time to initiation of RRT was also shorter compared with the Ringer's group (HR 1.40; 95% CI 1.01–1.93; P = 0.04). The intervention effect of HES on mortality was reduced when adjusting for AKI stage as a time‐dependent covariate (P = 0.15).
Conclusion
In patients with severe sepsis, HES appeared to increase the rate of severe AKI and use of RRT within the first 5 days. The increased mortality observed with HES may have been partly mediated through acute kidney impairment.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.12453</identifier><identifier>PMID: 25524831</identifier><identifier>CODEN: AANEAB</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Acute Kidney Injury - mortality ; Adult ; Aged ; Comorbidity ; Female ; Fluid Therapy - methods ; Humans ; Hydroxyethyl Starch Derivatives - therapeutic use ; Incidence ; Isotonic Solutions - therapeutic use ; Male ; Medical research ; Middle Aged ; Mortality ; Plasma Substitutes - therapeutic use ; Prospective Studies ; Renal Replacement Therapy - statistics & numerical data ; Scandinavian and Nordic Countries - epidemiology ; Sepsis ; Sepsis - mortality ; Sepsis - therapy ; Time Factors</subject><ispartof>Acta anaesthesiologica Scandinavica, 2015-03, Vol.59 (3), p.329-336</ispartof><rights>2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd</rights><rights>2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2015 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4943-171b687a46e9e2c04bcdb459995785a186607c1518e8d14d6c761369bad94b483</citedby><cites>FETCH-LOGICAL-c4943-171b687a46e9e2c04bcdb459995785a186607c1518e8d14d6c761369bad94b483</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Faas.12453$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Faas.12453$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25524831$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>MÜLLER, R. B.</creatorcontrib><creatorcontrib>HAASE, N.</creatorcontrib><creatorcontrib>LANGE, T.</creatorcontrib><creatorcontrib>WETTERSLEV, J.</creatorcontrib><creatorcontrib>PERNER, A.</creatorcontrib><title>Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>Background
We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial.
Methods
In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury (AKI) in the HES vs. Ringer's acetate groups using the Kidney Disease: Improving Global Outcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy (RRT).
Results
At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. Ringer's group within the first 5 days after randomisation (P = 0.03), the average difference being 0.2 points (P < 0.01). An increase in AKI stage was associated with mortality (hazard ratio (HR) 1.35; 95% CI 1.22 to 1.49; P < 0.01). Significantly, more patients in the HES group received RRT within the first 5 days (P = 0.01), and the time to initiation of RRT was also shorter compared with the Ringer's group (HR 1.40; 95% CI 1.01–1.93; P = 0.04). The intervention effect of HES on mortality was reduced when adjusting for AKI stage as a time‐dependent covariate (P = 0.15).
Conclusion
In patients with severe sepsis, HES appeared to increase the rate of severe AKI and use of RRT within the first 5 days. The increased mortality observed with HES may have been partly mediated through acute kidney impairment.</description><subject>Acute Kidney Injury - mortality</subject><subject>Adult</subject><subject>Aged</subject><subject>Comorbidity</subject><subject>Female</subject><subject>Fluid Therapy - methods</subject><subject>Humans</subject><subject>Hydroxyethyl Starch Derivatives - therapeutic use</subject><subject>Incidence</subject><subject>Isotonic Solutions - therapeutic use</subject><subject>Male</subject><subject>Medical research</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Plasma Substitutes - therapeutic use</subject><subject>Prospective Studies</subject><subject>Renal Replacement Therapy - statistics & numerical data</subject><subject>Scandinavian and Nordic Countries - epidemiology</subject><subject>Sepsis</subject><subject>Sepsis - mortality</subject><subject>Sepsis - therapy</subject><subject>Time Factors</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1P4zAQhi20CErZA39gFWkvyyGtJ_6KjxVavj8ELOJoOc6gpqRNsRMg_x5DgQPSCl9Glp55NDMvITtARxDf2NowgowLtkYGwLROpVDyBxlQSiEVoLJNshXCLH4Z13qDbGZCZDxnMCD7E9e1mNxX5QL7pFrMOt8nT1U7TaZ96ZvnHttpXyehtd5NE2B0TEc8i2AS8BE9xrIMVdgm63e2DvjzvQ7Jzf7ff3uH6enFwdHe5DR1XHOWgoJC5spyiRozR3nhyoILrbVQubCQS0mVAwE55iXwUjolgUld2FLzIk48JH9W3qVvHjoMrZlXwWFd2wU2XTCQa8VyGWXfozIeQSgd5xqS31_QWdP5RVzkleIKBGcQqd0V5XwTgsc7s_TV3PreADWvOZiYg3nLIbK_3o1dMcfyk_w4fATGK-CpqrH_v8lMJtcfynTVUYUWnz87rL83UjElzO35gTnXV7fi-OTSnLEXUiucxw</recordid><startdate>201503</startdate><enddate>201503</enddate><creator>MÜLLER, R. B.</creator><creator>HAASE, N.</creator><creator>LANGE, T.</creator><creator>WETTERSLEV, J.</creator><creator>PERNER, A.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>201503</creationdate><title>Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis</title><author>MÜLLER, R. B. ; HAASE, N. ; LANGE, T. ; WETTERSLEV, J. ; PERNER, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4943-171b687a46e9e2c04bcdb459995785a186607c1518e8d14d6c761369bad94b483</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acute Kidney Injury - mortality</topic><topic>Adult</topic><topic>Aged</topic><topic>Comorbidity</topic><topic>Female</topic><topic>Fluid Therapy - methods</topic><topic>Humans</topic><topic>Hydroxyethyl Starch Derivatives - therapeutic use</topic><topic>Incidence</topic><topic>Isotonic Solutions - therapeutic use</topic><topic>Male</topic><topic>Medical research</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Plasma Substitutes - therapeutic use</topic><topic>Prospective Studies</topic><topic>Renal Replacement Therapy - statistics & numerical data</topic><topic>Scandinavian and Nordic Countries - epidemiology</topic><topic>Sepsis</topic><topic>Sepsis - mortality</topic><topic>Sepsis - therapy</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>MÜLLER, R. B.</creatorcontrib><creatorcontrib>HAASE, N.</creatorcontrib><creatorcontrib>LANGE, T.</creatorcontrib><creatorcontrib>WETTERSLEV, J.</creatorcontrib><creatorcontrib>PERNER, A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>MÜLLER, R. B.</au><au>HAASE, N.</au><au>LANGE, T.</au><au>WETTERSLEV, J.</au><au>PERNER, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2015-03</date><risdate>2015</risdate><volume>59</volume><issue>3</issue><spage>329</spage><epage>336</epage><pages>329-336</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><coden>AANEAB</coden><abstract>Background
We aimed to detail the effects of hydroxyethyl starch (HES) vs. Ringer's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial.
Methods
In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury (AKI) in the HES vs. Ringer's acetate groups using the Kidney Disease: Improving Global Outcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy (RRT).
Results
At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. Ringer's group within the first 5 days after randomisation (P = 0.03), the average difference being 0.2 points (P < 0.01). An increase in AKI stage was associated with mortality (hazard ratio (HR) 1.35; 95% CI 1.22 to 1.49; P < 0.01). Significantly, more patients in the HES group received RRT within the first 5 days (P = 0.01), and the time to initiation of RRT was also shorter compared with the Ringer's group (HR 1.40; 95% CI 1.01–1.93; P = 0.04). The intervention effect of HES on mortality was reduced when adjusting for AKI stage as a time‐dependent covariate (P = 0.15).
Conclusion
In patients with severe sepsis, HES appeared to increase the rate of severe AKI and use of RRT within the first 5 days. The increased mortality observed with HES may have been partly mediated through acute kidney impairment.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>25524831</pmid><doi>10.1111/aas.12453</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; Wiley Journals |
| subjects | Acute Kidney Injury - mortality Adult Aged Comorbidity Female Fluid Therapy - methods Humans Hydroxyethyl Starch Derivatives - therapeutic use Incidence Isotonic Solutions - therapeutic use Male Medical research Middle Aged Mortality Plasma Substitutes - therapeutic use Prospective Studies Renal Replacement Therapy - statistics & numerical data Scandinavian and Nordic Countries - epidemiology Sepsis Sepsis - mortality Sepsis - therapy Time Factors |
| title | Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis |
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