The risk associated with hyperoncotic colloids in patients with shock

Area of Science:

• Critical Care Medicine
• Nephrology
• Pharmacology

Background:

• Fluid resuscitation strategies for shock often involve crystalloids and colloids.
• Colloids differ in their oncotic characteristics, influencing fluid shifts and organ perfusion.
• The safety of various colloid types in shock management remains a subject of investigation.

Purpose of the Study:

• To assess the risk of renal adverse events in patients with shock resuscitated with different oncotic fluid strategies.
• To compare the incidence of renal events and mortality associated with hypo-oncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin, and crystalloids.
• To evaluate the impact of fluid choice on patient outcomes in the intensive care unit (ICU).

Main Methods:

• An international prospective cohort study included 1,013 ICU patients requiring fluid resuscitation for shock.
• Patients with cirrhosis or receiving plasma were excluded from the analysis.
• Multivariate analyses and propensity score matching were used to adjust for confounding factors, including patient severity and risk factors for renal failure.

Main Results:

• Renal events occurred in 17% of patients.
• The use of artificial hyperoncotic colloids (OR: 2.48) and hyperoncotic albumin (OR: 5.99) was significantly associated with an increased risk of renal events after statistical adjustment.
• Overall ICU mortality was 27.1%, with hyperoncotic albumin use showing a significant association with increased ICU death (OR: 2.79).

Conclusions:

• The study suggests potential harmful effects of hyperoncotic colloids on renal function and patient outcomes.
• While improper usage and confounding factors cannot be entirely excluded, the findings warrant caution regarding the use of hyperoncotic colloids.
• Safer fluid resuscitation alternatives exist, and their use should be considered, particularly in patients at risk for renal complications.