Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery

Area of Science:

• Anesthesiology and Critical Care Medicine
• Cardiovascular Surgery
• Nephrology

Background:

• Hydroxyethyl starches (HES) are commonly used as intravenous fluids in major surgeries.
• The impact of HES on renal function and transfusion requirements in cardiac surgery remains a subject of investigation.

Purpose of the Study:

• To evaluate the association between two types of HES administration and renal integrity in patients undergoing cardiac surgery.
• To assess the effect of HES on the need for blood product transfusions, including red blood cells, fresh frozen plasma, cryoprecipitate, and platelets.

Main Methods:

• Retrospective analysis of 1,265 patients undergoing coronary artery bypass graft (CABG) and/or valve surgery with cardiopulmonary bypass.
• Intraoperative administration of HES and blood products was recorded.
• Propensity modeling was used to analyze associations between HES, patient characteristics, and outcomes.

Main Results:

• No significant difference in acute kidney injury (AKI) was observed between patients receiving HES and those who did not.
• Higher volumes of HES (≥1,000 mL) were associated with increased transfusions of fresh frozen plasma, cryoprecipitate, and platelets.
• Patients with chronic kidney disease (CKD) stages 3-5 were less likely to receive HES.

Conclusions:

• HES administration in cardiac surgery was not associated with an increased risk of postoperative AKI or red blood cell transfusion.
• Despite a higher rate of certain blood product transfusions with HES, surgical mortality did not differ between HES and non-HES groups.