Article Sidebar

Submitted
4 November 2016
Accepted
4 November 2016
Published
15 November 2016
Download
PDF
Statistic
Read Counter : 1084 Download : 948

Main Article Content

Abstract

Hydroxyethyl Starch (HES) is a compound that improves intravascular volume effectively and rapidly without causing tissue edema. However, HES also has renal safety profile which is still being debated. Based on clinical experience in Dr. Soetomo Hospital, the frequency of acute renal failure following HES 200/0.5 administration at a dose of less than 20 ml/kg (maximum dose) is very rare. The purpose of this study was to evaluate the effect of HES 200/0.5 at a dose of less than 20 ml/kg in patients undergoing surgery. N-acetyl-b-D-Glucosaminidase (NAG) per urine creatinine ratio and creatinine serum were used as main parameter to assess renal injury. This research was observational and prospective design in patients undergoing elective surgery at Gedung Bedah Pusat Terpadu, Dr. Soetomo Hospital, who requiring resuscitation therapy with HES 200/0.5 and met the inclusion and exclusion criteria. NAG was measured prior to surgery and 12 hours after administration of fluid therapy, while creatinine serum was observed before surgery and 48 hours after resuscitation. This study was conducted for three months, and obtained 50 subjects divided into 2 groups, crystalloid group and HES 200/0.5 group. Demographic and baseline characteristics did not differ between groups, except the total bleeding volume. Total bleeding in HES 200/0.5group was higher than crystalloid group (p <0.0001). The mean volume of fluid received in HES 200/0.5 group was 2042.0 ± 673.9 mL, higher when compared with that of crystalloid group (910.0 ± 592.0 ml). Doses of HES 200/0.5 received was 8.31 ± 4.86 ml/kg. Measurement of the of NAG/creatinine ratio and creatinine serum showed significant increase in both groups, but still within the normal range. In addition, the value of these two parameters did not differ between groups. In conclusion, HES 200/0.5 in a dose of less than 20 ml/kg is safe to use in patients who suffered from hypovolemic hemorrhage, without prior history of renal impairment.

Keywords

hyroxyethyl starch acute renal failure n-acetyl--d-glucosaminidase creatinine serum

Article Details

License

  • Folia Medica Indonesiana is a scientific peer-reviewed article which freely available to be accessed, downloaded, and used for research purposes. Folia Medica Indonesiana (p-ISSN: 2541-1012; e-ISSN: 2528-2018) is licensed under a Creative Commons Attribution 4.0 International License. Manuscripts submitted to Folia Medica Indonesiana are published under the terms of the Creative Commons License. The terms of the license are:

    Attribution ” You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

    NonCommercial ” You may not use the material for commercial purposes.

    ShareAlike ” If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.

    No additional restrictions ” You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.

    You  are free to :

    Share ” copy and redistribute the material in any medium or format.

    Adapt ” remix, transform, and build upon the material.

How to Cite
Shinta, D. W., Khotib, J., Rahardjo, E., Rahmadi, M., & Suprapti, B. (2016). THE USE OF HYDROXYETHYL STARCH 200/0,5 AS PLASMA SUBTITUTES IS SAFE IN HYPOVOLEMIC PATIENTS AS INDICATED IN CHANGES OF N-ACETYL--GLUCOSAMINIDASE AND CREATININ SERUM PARAMETERS. Folia Medica Indonesiana, 51(4), 228–233. https://doi.org/10.20473/fmi.v51i4.2852
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Ahsan N, Palmer BF, Wheeler D, Greenlee RG Jr, Toto RD (1994). Intravenous immunoglobulin-induced osmotic nephrosis. Arch Intern Med 154, 1985–1987
  2. Al-Khafaji A and Webb AR (2004). Fluid resuscitation. Contin Educ Anaesth Crit Care Pain 4, 127–131
  3. Baron JF (2000b). Crystalloids versus colloids in the treatment of hypovolemic shock. In: Vincent JL (ed). Yearbook of Intensive Care and Emergency Medicine 2000, New York, Springer, p 443–466
  4. Baron JF (2000a). Adverse effects of colloids on renal function. In: Vincent JL (ed). Yearbook of Intensive Care and Emergency Medicine 2000, New York, Springer, p 486–493
  5. Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K; German Competence Network Sepsis (SepNet) (2008). Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358, 125-139
  6. Cittanova ML, Leblanc I, Legendre C, Mouquet C, Riou B, Coriat P (1996). Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet 348, 1620-1622
  7. Dehne MG, Mühling J, Sablotzki A, Dehne K, Sucke N, Hempelmann G (2001). Hydroxyethyl starch (HES) does not directly affect renal function in patients with no prior renal impairment. J Clin Anesth 13, 103-111
  8. Deman A, Peeters P, Sennesael J (1999). Hydroxyethyl starch does not impair immediate renal function in kidney transplant recipients: a retrospective, multicentre analysis. Nephrol Dial Transplant 14, 1517-1520
  9. Diehl JT, Lester JL 3rd, Cosgrove DM (1982). Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg 34, 674–679
  10. Diomi P, Ericsson JL, Matheson NA (1970). Effects of dextran 40 on urine flow and composition during renal hypoperfusion in dogs with osmotic nephrosis. Ann Surg 172, 813–824
  11. DiScala VA, Mautner W, Cohen JA, Levitt MF, Churg J, Yunis SL (1965). Tubular alterations produced by osmotic diuresis with mannitol. Ann Intern Med 63, 767–775
  12. Guidet B, Martinet O, Boulain T, Philippart F, Poussel JF, Maizel J, Forceville X, Feissel M, Hasselmann M, Heininger A, Van Aken H (2012). Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Crit Care 16, R94
  13. Hauet T, Faure JP, Baumert H, Bardou A, Gibelin H, Beguinot S, Germonville T, Hebrard W, Choulet P, Carretier M, Eugene M (1998). Influence of different colloids on hemodynamic and renal functions: comparative study in an isolated perfused pig kidney model. Transplant Proc 30, 2796-2797
  14. Kumle B, Boldt J, Piper S, Schmidt C, Suttner S, Salopek S (1999). The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesth Analg 89, 1124-1130
  15. Legendre C, Thervet E, Page B, Percheron A, Noí«l LH, Kreis H (1993). Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet 342, 248-249
  16. Macintyre E, Mackie IJ, Ho D, Tinker J, Bullen C, Machin SJ (1985). The haemostatic effects of hydroxyethyl starch (HES) used as a volume expander. Intensive Care Med 11, 300-303
  17. Matheson N and Diomi P (1970). Renal failure after the administration of dextran 40. Surg Gynecol Obstet 131, 661–668
  18. Moggio RA, Rha CC, Somberg ED, Praeger PI, Pooley RW, Reed GE (1983). Hemodynamic comparison of albumin and hydroxyethyl starch in postoperative cardiac surgery patients. Crit Care Med 11, 943-945
  19. Moran M and Kapsner C (1987). Acute renal failure associated with elevated plasma oncotic pressure. N Engl J Med 317, 150-153
  20. Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald WJ (1994). Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep. J Appl Physiol 77, 1507-1518
  21. Munsch CM, MacIntyre E, Machin SJ, Mackie IJ, Treasure T (1988). Hydroxyethyl starch: an alternative to plasma for postoperative volume expansion after cardiac surgery. Br J Surg 75, 675-678
  22. Mutter TC, Ruth CA, Dart AB (2013). Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function. Cochrane Database Syst Rev 7, CD007594
  23. Myburgh JA and Mythen MG (2013). Resuscitation fluids. N Engl J Med 369, 1243–1251
  24. Neff TA, Doelberg M, Jungheinrich C, Sauerland A, Spahn DR, Stocker R (2003). Repetitive large-dose infusion of the novel hydroxyethyl starch 130/0.4 in patients with severe head injury. Anesth Analg 96, 1453-1459
  25. Novikov M and Smith CE (2008). Fluid and blood therapy in trauma. International Trauma Care 18, 42–56
  26. Schortgen F, Lacherade JC, Bruneel F, Cattaneo I, Hemery F, Lemaire F, Brochard L (2001). Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet 357, 911-916
  27. Spaniol JR, Knight AR, Zebley JL, Anderson D, Pierce JD (2007). Fluid resuscitation therapy for hemorrhagic shock. J Trauma Nurs 14, 152-160
  28. Stainsby D, MacLennan S, Hamilton PJ (2000). Management of massive blood loss: a template guideline. Br J Anaesth 85, 487-491
  29. Standl T, Lipfert B, Reeker W, Schulte am Esch J, Lorke DE (1996). Acute effects of complete blood exchange with ultra-purified hemoglobin solution or hydroxyethyl starch on liver and kidney in the animal model. Anasthesiol Intensivmed Notfallmed Schmerzther 31, 354-361
  30. Zarychanski R, Abou-Setta AM, Turgeon AF, Houston BL, McIntyre L, Marshall JC, Fergusson DA (2013). Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. JAMA 309, 678-688

Most read articles by the same author(s)