Hydroxyethylstarch used for plasma-volume restoration in brain-dead kidney donors has previously been associated with impaired kidney function in the transplant recipients.
Frédérique Schortgen and colleagues from Hopital Henri Mondor, Paris, France, conducted a multicenter, randomized study to assess the frequency of ARF in patients with severe sepsis or septic shock treated with hydroxyethylstarch or gelatin.
Adults with severe sepsis or septic shock from three intensive-care units in France were enrolled prospectively in the study. They were randomly assigned 6% hydroxyethylstarch or 3% fluid-modified gelatin.
The primary endpoint measured was ARF (a two-fold increase in serum creatinine from baseline or need for renal replacement therapy).
Frequency of acute renal failure after treatment:|
129 patients were enrolled over 18 months. Severity of illness, and serum creatinine, were similar at baseline in the hydroxyethylstarch and gelatin groups. However, the frequency of ARF (42% compared with 23%), was significantly higher in the hydroxyethylstarch group.
Frédérique Schortgen comments, "We suggest that the hydroxyethylstarch we used is best avoided in patients at risk of ARF - i.e. in all patients with volume depletion who require fluid loading.
"In the absence of data on other rapidly degradable hydroxyethylstarches, these compounds should be viewed with caution in patients at risk of ARF."
"Use of other compounds or crystalloids, which have no reported adverse effects, may reduce the risk of renal injury in critically ill patients," it was concluded.