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Acute kidney injury with hydroxyethyl starch 130/0.42 in severe sepsis
Author(s) -
MÜLLER R. B.,
HAASE N.,
LANGE T.,
WETTERSLEV J.,
PERNER A.
Publication year - 2015
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12453
Subject(s) - medicine , hydroxyethyl starch , acute kidney injury , sepsis , renal replacement therapy , septic shock , resuscitation , hazard ratio , renal function , shock (circulatory) , kidney disease , anesthesia , confidence interval
Background We aimed to detail the effects of hydroxyethyl starch ( HES ) vs. R inger's on kidney function including the interaction with mortality in post‐hoc analyses as resuscitation with HES 130/0.42 increased mortality in the S candinavian S tarch for S evere S epsis/ S eptic S hock (6 S ) trial. Methods In all 798 randomised patients, we assessed the incidence and effect on mortality of acute kidney injury ( AKI ) in the HES vs. R inger's acetate groups using the K idney D isease: I mproving G lobal O utcome criteria. We also assessed the intervention effect on time to and duration of renal replacement therapy ( RRT ). Results At baseline, the intervention groups were similar. The maximal AKI stage was higher in the HES vs. R inger's group within the first 5 days after randomisation ( P = 0.03), the average difference being 0.2 points ( P < 0.01). An increase in AKI stage was associated with mortality (hazard ratio ( HR ) 1.35; 95% CI 1.22 to 1.49; P < 0.01). Significantly, more patients in the HES group received RRT within the first 5 days ( P = 0.01), and the time to initiation of RRT was also shorter compared with the R inger's group ( HR 1.40; 95% CI 1.01–1.93; P = 0.04). The intervention effect of HES on mortality was reduced when adjusting for AKI stage as a time‐dependent covariate ( P = 0.15). Conclusion In patients with severe sepsis, HES appeared to increase the rate of severe AKI and use of RRT within the first 5 days. The increased mortality observed with HES may have been partly mediated through acute kidney impairment.