Effects of hydroxyethyl starch and gelatin solutions on renal function in surgical intensive care unit patients

Background

There is continuing concern regarding adverse renal effects of colloid solutions in ICU patients.

Objective

To compare two colloids, hydroxyethyl starch (HES 6% 130/.04) and gelatin 4%, on renal function in ICU patients.

Methods

A before–after study of surgical ICU patients. Consecutive patients admitted from January to June 2005 formed Group HES, with HES as the standard colloid of choice. Patients admitted from January to June 2006 formed Group GEL, with gelatin as the primary colloid administered.

Results

There were 1,383 patients in Group HES and 1,528 in Group GEL; 118 and 87 patients, respectively, had severe sepsis. There were some differences between groups in comorbidities and surgical procedures for the patients overall; however, these characteristics were more closely matched in the subset of severe sepsis patients. The incidence of renal failure and the ICU and hospital mortalities were similar in the two groups. In multivariate analysis, cumulative doses >33 ml/kg of either HES (odds ratio = 1.85, 95% confidence interval = 1.01 to 3.41, P < 0.001) or gelatin (odds ratio = 1.99, 95% confidence interval = 1.05 to 3.79, P = 0.035) were associated with higher risk of renal failure. In severe sepsis, hospital mortality tended to be higher in Group HES than in Group GEL (43% vs. 31%, P = 0.076). Patients with severe sepsis who received a cumulative dose >33 ml/kg of either colloid had a higher incidence of renal failure, which reached statistical significance for the HES group.

Conclusion

Moderate cumulative doses of modern HES or gelatin solutions are associated with higher risk for acute renal failure. These solutions should be used with caution, especially in severe sepsis, until their safety can be demonstrated.