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6% HETASTARCH IN LACTATED RINGERS IS ASSOCIATED WITH RENAL FAILURE IN PATIENTS UNDERGOING CARDIOPULMONARY BYPASS
Eric J. Lehr, Taylor Mesojednik, Riley Stout, Samuel Youssef, Glenn Barnhart, Bob Fletcher, David Stout.
Swedish Heart and Vascular Institute, Seattle, WA, USA.
OBJECTIVE: Postsurgical volume resuscitation with 6% Hetastarch in Lactated Ringers (HES) in non-cardiac surgical patients has been associated with postoperative renal failure. However, there are limited data on the effect of HES on renal outcomes in cardiac surgical patients. We sought to determine the effect of HES in patients at various risk of renal failure undergoing cardiac surgery.
METHODS: We retrospectively reviewed all 1,161 patients undergoing cardiac surgical procedures from January 2010 to April 2012 at our institution. Patients were stratified by their acute renal failure score, which is a composite of risk factors for renal failure (gender, type of surgery, incidence of surgery, procedure status, history of CHF, history of COPD, insulin dependence, left ventricular ejection fraction less than 35%, pre-operative creatinine, and pre-operative intraaortic balloon pump and by whether they received HES intraoperatively or postoperatively in the intensive care unit.
RESULTS: New renal failure occurred in 3.8 % of patients who did not receive HES, but in 6.9 % of patients who received HES in the operating room (p<0.05). Patients with an acute renal score of < 7 had a higher rate of new renal failure when receiving HES in the operating room, whereas patients with an acute renal score of 7 or higher had a lower rate of new renal failure when HES was administered in the operating room. New renal failure was higher in patients who received HES in either the operating room or the intensive care unit and was highest in patient who were treated with HES in both the operating room and the intensive care unit (2.3 % vs. 6.0 % vs. 8.3 %, p < 0.0001). The odds ratio for renal failure (with 95% Confidence Intervals) after treatment with HES either in the operating room and/or the intensive care unit was 1.87 (CI 1.10-3.18) after adjusting for ARF score.
CONCLUSIONS: Administration of HES in cardiac surgical patients either intraoperatively or postoperatively in the intensive care unit was negatively associated with new renal failure. Volume replacement with HES should be avoided in patients undergoing cardiac surgery to minimize the risk for new renal failure.
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