BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):457-464; doi:10.1093/bja/aen016
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients
Department of Anaesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany
* Corresponding author. E-mail: boldtj{at}gmx.net/ jboldt{at}gmx.net
Background: The effects of hydroxyethylstarch (HES) 130/0.4 6% and gelatin 4% on inflammation, endothelial integrity, and renal function after cardiac surgery were compared.
Methods: Sixty patients aged >80 yr undergoing cardiac surgery were randomized to receive gelatin (n=30) or HES 130/0.4 (n=30). The colloid was used in the priming of the cardiopulmonary bypass circuit (500 ml) and for volume replacement until the second postoperative day (POD). Serum creatinine, creatinine clearance, IL-6, IL-10, intercellular adhesion molecule-1 (sICAM-1), urinary glutathione transferase-
, and neutrophil gelatinase-associated lipocalin (NGAL) were measured perioperatively. Serum creatinine was also reported 
60 days after discharge.
Results: The mean(SD) volume of gelatin infused was 4180(440) ml, which was greater than the volume of HES infused 2910(330) ml (P=0.002). The mean(SD) volume of serum creatinine on the first POD was 151(24) µmol litre–1 in the gelatin group and 126(13) µmol litre–1 in the HES group (P=0.004). Values for the second POD were 161(0.26) and 133(16) µmol litre–1, respectively (P=0.004). Creatinine clearance was lower in the gelatin group on the first POD [37(7) vs 46(8) ml min–1 1.73 m2 (P=0.004)] and the second POD [32(8) vs 45(10) ml min–1 1.73 m2 (P=0.002)]. Kidney function 60 days after discharge did not differ between the groups. IL-6, IL-10, and sICAM-1 were significantly lower in the HES group than in the gelatin group on the first and second PODs. Urinary -GST increased in both groups to a comparable extent. Urinary NGAL concentrations were higher in the gelatin than in the HES patients 5 h after surgery and on the first and second PODs.
Conclusions: In cardiac surgery patients aged >80 years, volume therapy with HES 130/0.4 6% was associated with less marked changes in kidney function and a less marked endothelial inflammatory response than gelatin 4%.
Keywords: cardiovascular system, effects; complications, renal; immune response; kidney, failure; surgery, cardiovascular
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  F. M. Brunkhorst, M. Oppert, M. Leone, V. Blasco, J. Albanese, and C. Martin Nephrotoxicity of hydroxyethyl starch solution Br. J. Anaesth., June 1, 2008; 100(6): 856 - 857. [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- Comparison of gelatin and a modern hydroxyethylstarch on renal function
- Norman Kufakwaro
- British Journal of Anaesthesia, 13 Apr 2008 [Full text]
- Renal side effects of hydroxyethyl starch 130/0.4 in cardiac surgery
- Ingemar J. Davidson
- British Journal of Anaesthesia, 28 May 2008 [Full text]