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[Volume replacement with hydroxyethyl starch: is there an influence on kidney function?].

S Suttner1, J Boldt

  • 1Klinik für Anästhesie und Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen. suttner@gmx.de

Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
|February 10, 2004
PubMed
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Hydroxyethyl starch (HES) solutions, when rapidly degradable with low molecular weight, pose minimal risk to kidney function. However, high doses of slow-degradable HES may increase the risk of renal dysfunction.

Area of Science:

  • Pharmacology
  • Nephrology
  • Colloid Chemistry

Background:

  • Hydroxyethyl starch (HES) solutions are synthetic colloids used clinically.
  • Available HES preparations vary in concentration, molecular weight (Mw), and hydroxyethylation, affecting their properties.
  • HES elimination depends on Mw and degree of substitution (DS), influencing intravascular half-life and side effects.

Purpose of the Study:

  • To analyze the relationship between HES properties and renal function.
  • To investigate the mechanisms of HES-induced renal dysfunction.
  • To evaluate the safety of different HES preparations in various clinical contexts.

Main Methods:

  • Review of existing literature on HES pharmacology and renal effects.
  • Analysis of HES elimination pathways based on molecular characteristics (Mw, DS).

Related Experiment Videos

  • Examination of reported cases of renal dysfunction associated with HES administration.

    • Main Results:

    • Renal dysfunction and acute renal failure have been reported with HES, particularly in patients with risk factors like pre-existing renal disease or dehydration.
    • The proposed mechanism involves osmotic nephrosis-like lesions and tubular obstruction due to hyperviscous urine.
    • Slowly degradable HES with high Mw and DS, or high concentrations, may increase the risk of renal impairment.
    • Rapidly degradable HES solutions (e.g., HES 130/0.4) with low Mw and DS do not appear to increase renal dysfunction risk, even in large perioperative doses.

    Conclusions:

    • HES-induced renal dysfunction is likely due to osmotic effects and tubular obstruction, not direct toxicity.
    • Risk factors and HES characteristics (Mw, DS, concentration, degradability) significantly influence renal safety.
    • Modern, rapidly degradable HES solutions are associated with a lower risk of renal adverse effects, especially when administered with adequate hydration.