Effects of hydroxyethyl starch administration on renal function in critically ill patients
Identifieur interne : 000B26 ( France/Analysis ); précédent : 000B25; suivant : 000B27Effects of hydroxyethyl starch administration on renal function in critically ill patients
Auteurs : Y. Sakr [Allemagne] ; D. Payen [France] ; K. Reinhart [Allemagne] ; F. S. Sipmann [Espagne] ; E. Zavala [Espagne] ; J. Bewley [Royaume-Uni] ; G. Marx [Allemagne] ; J.-L. Vincent [Belgique]Source :
- British Journal of Anaesthesia [ 0007-0912 ] ; 2007-02.
Abstract
Background The influence of hydroxyethyl starch (HES) solutions on renal function is controversial. We investigated the effect of HES administration on renal function in critically ill patients enrolled in a large multicentre observational European study. Methods All adult patients admitted to the 198 participating intensive care units (ICUs) during a 15-day period were enrolled. Prospectively collected data included daily fluid administration, urine output, sequential organ failure assessment (SOFA) score, serum creatinine levels, and the need for renal replacement therapy (RRT) during the ICU stay. Results Of 3147 patients, 1075 (34) received HES. Patients who received HES were older [mean (sd): 62 (sd17) vs 60 (18) years, P 0.022], more likely to be surgical admissions, had a higher incidence of haematological malignancy and heart failure, higher SAPS II [40.0 (17.0) vs 34.7 (16.9), P < 0.001] and SOFA [6.2 (3.7) vs 5.0 (3.9), P < 0.001] scores, and less likely to be receiving RRT (2 vs 4, P < 0.001) than those who did not receive HES. The renal SOFA score increased significantly over the ICU stay independent of the type of fluid administered. Although more patients who received HES needed RRT than non-HES patients (11 vs 9, P 0.006), HES administration was not associated with an increased risk for subsequent RRT in a multivariable analysis [odds ratio (OR): 0.417, 95 confidence interval (CI): 0.053.27, P 0.406]. Sepsis (OR: 2.03, 95 CI: 1.373.02, P < 0.001), cardiovascular failure (OR: 6.88, 95 CI: 4.4910.56, P < 0.001), haematological cancer (OR: 2.83, 95 CI: 1.286.25, P 0.01), and baseline renal SOFA scores > 1 (P < 0.01 for renal SOFA 2, 3, and 4 with renal SOFA 0 as a reference) were all associated with a higher need for RRT. Conclusions In this observational study, haematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for the subsequent need for RRT in the ICU. The administration of HES had no influence on renal function or the need for RRT in the ICU.
Url:
DOI: 10.1093/bja/ael333
Affiliations:
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Reinhart</name><affiliation wicri:level="1"><country xml:lang="fr">Allemagne</country><wicri:regionArea>Friedrich-Schiller-University, Jena</wicri:regionArea><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author><author><name sortKey="Sipmann, F S" sort="Sipmann, F S" uniqKey="Sipmann F" first="F. S." last="Sipmann">F. S. Sipmann</name><affiliation wicri:level="3"><country xml:lang="fr">Espagne</country><wicri:regionArea>Fundacin Jimnez Daz, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Zavala, E" sort="Zavala, E" uniqKey="Zavala E" first="E." last="Zavala">E. 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Vincent</name><affiliation></affiliation><affiliation wicri:level="1"><country wicri:rule="url">Belgique</country></affiliation></author></analytic><monogr></monogr><series><title level="j">British Journal of Anaesthesia</title><title level="j" type="abbrev">Br J Anaesth</title><idno type="ISSN">0007-0912</idno><idno type="eISSN">1471-6771</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2007-02">2007-02</date><biblScope unit="volume">98</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="216">216</biblScope><biblScope unit="page" to="224">224</biblScope></imprint><idno type="ISSN">0007-0912</idno></series><idno type="istex">D68F9DBDE53F44F60A256C642806F7757808A113</idno><idno type="DOI">10.1093/bja/ael333</idno><idno type="ArticleID">ael333</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0007-0912</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background The influence of hydroxyethyl starch (HES) solutions on renal function is controversial. We investigated the effect of HES administration on renal function in critically ill patients enrolled in a large multicentre observational European study. Methods All adult patients admitted to the 198 participating intensive care units (ICUs) during a 15-day period were enrolled. Prospectively collected data included daily fluid administration, urine output, sequential organ failure assessment (SOFA) score, serum creatinine levels, and the need for renal replacement therapy (RRT) during the ICU stay. Results Of 3147 patients, 1075 (34) received HES. Patients who received HES were older [mean (sd): 62 (sd17) vs 60 (18) years, P 0.022], more likely to be surgical admissions, had a higher incidence of haematological malignancy and heart failure, higher SAPS II [40.0 (17.0) vs 34.7 (16.9), P < 0.001] and SOFA [6.2 (3.7) vs 5.0 (3.9), P < 0.001] scores, and less likely to be receiving RRT (2 vs 4, P < 0.001) than those who did not receive HES. The renal SOFA score increased significantly over the ICU stay independent of the type of fluid administered. Although more patients who received HES needed RRT than non-HES patients (11 vs 9, P 0.006), HES administration was not associated with an increased risk for subsequent RRT in a multivariable analysis [odds ratio (OR): 0.417, 95 confidence interval (CI): 0.053.27, P 0.406]. Sepsis (OR: 2.03, 95 CI: 1.373.02, P < 0.001), cardiovascular failure (OR: 6.88, 95 CI: 4.4910.56, P < 0.001), haematological cancer (OR: 2.83, 95 CI: 1.286.25, P 0.01), and baseline renal SOFA scores > 1 (P < 0.01 for renal SOFA 2, 3, and 4 with renal SOFA 0 as a reference) were all associated with a higher need for RRT. Conclusions In this observational study, haematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for the subsequent need for RRT in the ICU. The administration of HES had no influence on renal function or the need for RRT in the ICU.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Belgique</li><li>Espagne</li><li>France</li><li>Royaume-Uni</li></country><region><li>Communauté de Madrid</li></region><settlement><li>Madrid</li><li>Paris</li></settlement></list><tree><country name="Allemagne"><noRegion><name sortKey="Sakr, Y" sort="Sakr, Y" uniqKey="Sakr Y" first="Y." last="Sakr">Y. Sakr</name></noRegion><name sortKey="Marx, G" sort="Marx, G" uniqKey="Marx G" first="G." last="Marx">G. Marx</name><name sortKey="Reinhart, K" sort="Reinhart, K" uniqKey="Reinhart K" first="K." last="Reinhart">K. Reinhart</name></country><country name="France"><noRegion><name sortKey="Payen, D" sort="Payen, D" uniqKey="Payen D" first="D." last="Payen">D. Payen</name></noRegion></country><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Sipmann, F S" sort="Sipmann, F S" uniqKey="Sipmann F" first="F. 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