Effect of 7.2% NaCl/6% Hydroxyethyl Starch 200/0.5 Solution on Renal Function during Surgery under Extracorporeal Circulation

• Published in: Obshchai͡a︡ reanimatologii͡a Vol. 9; no. 5; p. 36
• Main Authors: Lomivorotov, V. V., Fominsky, E. V., Efremov, S. M., Nepomnyashchikh, V. A., Lomivorotov, V. N., Shilova, A. N., Chernyavsky, A. M.
• Format: Journal Article
• Language: English
• Published: Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia 20-10-2013
• Subjects: acute renal injury; aortocoronary bypass surgery; hydroxyethyl starch; hypertonic solution
• ISSN: 1813-9779; 2411-7110
• DOI: 10.15360/1813-9779-2013-5-36

Objective: to evaluate the safety of using 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution to develop acute renal injury (ARI) in patients after aortocoronary bypass surgery (ACBS) under extracorporeal circulation (EC). Subjects and methods. This was a single-center prospective, randomized, single-blind clinical trial. The patients singly received either 7.2% NaCl/6% hydroxyethyl starch 200/0.5 solution (a NC/HES group, n=20) or 0.9% NaCl (a control group, n=20) in a dose of 4 ml/kg for 30 min after induction of anesthesia. The primary endpoint was the rate of ARI diagnosed according to the recommendations of the International Organization KRIGO (Kidney Disease: Improving Global Outcomes). The secondary endpoints were serum cystatin C (sCys С), and urinary neutrophil gelatinase-associated lipocalin (uNGAL). Results. The rate of ARI was comparable in both patient groups. Thus, ARI was found in 4 (20%) patients in the NC/HES group and in 6 (30%) cases in the control group (p=0.72). During the first two postoperative days, the peak concentration of creatinine was significantly lower in the NC/HES group (101 (range 94—107) ^l/l) than in the control one (117 (range 100—127) ^l/l) (p=0.02). That of sCys C was substantially lower in the NC/HES group (0.83 (range 0.73—0.89) mg/l) than in the control one (1.02 (range 0.88—1.15) mg/l) (p=0.001). The patients of the NC/HES group had comparable peak of uNGAL concentrations (33 (range 5—38) ng/ml) versus the controls (30 (range 21—50) ng/ml). Conclusion. The use of NC/HES does not cause any increase in the rate of ARI, increased renal injury, or a more significant decrease in glomerular filtration in patients after ACBS under EC. Key words: hypertonic solution, hydroxyethyl starch, acute renal injury, aortocoronary bypass surgery.