Balanced Hydroxyethylstarch (HES 130/0.4) Impairs Kidney Function In-Vivo without Inflammation

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Volume therapy is crucial in perioperative care, with ongoing debate on hydroxyethylstarch (HES) benefits.
• HES is contraindicated in sepsis due to increased acute kidney injury (AKI) risk, but its effects in non-septic patients are controversial.

Purpose of the Study:

• To investigate the impact of 6% HES 130/0.4 on kidney integrity in a sepsis model and under healthy conditions.
• To evaluate if HES induces AKI independently of sepsis.

Main Methods:

• Sepsis was induced using standardized Colon Ascendens Stent Peritonitis (sCASP) in rats.
• Groups received either HES (VOL) or no fluid, with or without sCASP, over 6 hours.
• Kidney function assessed via clearance tests, serum markers (urea, creatinine, cystatin C, NGAL), and histopathology. In vitro studies used human proximal tubule cells.

Main Results:

• Sepsis induced severe AKI, with HES potentially altering renal function measurements.
• HES administration alone (without sepsis) significantly deteriorated renal function and caused histopathological damage.
• In vitro, lipopolysaccharide did not exacerbate HES-induced reduction in proximal tubule cell viability.

Conclusions:

• HES 130/0.4 administration can induce AKI and kidney damage even in the absence of sepsis.
• The severity of septic AKI may not be influenced by the type of volume expansion used.
• Findings highlight the nephrotoxic potential of HES independent of septic insult.