Are different hydroxyethyl starch solutions an independent risk factor for acute kidney injury in surgical critically ill patients? A retrospective analysis of 3,591 patients

Introduction

Acute kidney injury (AKI) is a common complication associated with increased mortality among ICU patients. The purpose of the present study was to retrospectively analyze the influence of different, saline-based hydroxyethyl starch (HES) solutions (tetrastarch, 6% HES 130/0.4; pentastarch, 10% HES 200/0.5) on the risk of AKI in a cohort of surgical ICU patients.

Methods

Data for 3,591 patients admitted to one of four ICUs of the University Hospital of Muenster from January 2000 until August 2008 were extracted from an electronic database and analyzed using univariate and multivariate logistic regression analyses. AKI was defined as grade I or higher according to the RIFLE classification.

Results

Average amounts of colloid infusion per ICU day were 402 (231; 656) and 73 (36; 172) ml/day in patients treated with tetrastarch and pentastarch, respectively, whereas cumulative colloid amounts were 2,000 (500; 3,500) ml and 1,000 (500; 2,000) ml. Maximum daily infusion rates of 6% HES 130/0.4 and 10% HES 200/0.5 were below the pharmaceutically recommended daily dose limitations (that is, 50 and 20 ml/kg/day, respectively). The overall incidence of AKI was 20.4%. Multivariate logistic regression analysis revealed SOFA score (OR 1.597; 95% CI 1.543, 1.653), male gender (OR 1.455; 95% CI 1.153, 1.836), creatinine concentration on admission (OR 1.288; 95% CI 1.125, 1.475), and patient age (OR 1.017; 95% CI 1.009, 1.024) as independent risk factors for AKI. See Figure 1.

Figure 1

Risk factors for acute renal failure.

Conclusions

Neither of the investigated HES solutions (given within the recommended dose range) was an independent risk factor for AKI in the present cohort of surgical ICU patients.