Hydroxyethyl starch after major abdominal surgery not tied to higher risk of kidney injury

France: In major abdominal surgery, hydroxyethyl starch (HES) intravascular volume replacement was not linked with a greater incidence of 30-day acute kidney injury (AKI) as compared to crystalloid intravascular volume replacement, says an article published in Anesthesia & Analgesia.

Warnings concerning the risk of mortality and AKI using HES solutions have been issued in critically unwell patients. However, HES solutions may still have a role in major abdominal surgery. The purpose of this meta-analysis and trial sequential analysis (TSA) was to evaluate the risk of AKI, postoperative intra-abdominal complications, and intraoperative blood transfusion with HES intravascular volume replacement vs crystalloid intravascular volume replacement.

This meta-analysis looked for randomized controlled trials (RCTs) that compared intraoperative HES intravascular volume replacement versus crystalloid intravascular volume replacement in adults following major abdominal surgery. The primary outcome was 30-day AKI, which was defined as a binary outcome using Kidney Disease Improving Global Outcomes (KDIGO) criteria, which included stages 1, 2, and 3 into an AKI category against no AKI category (stage 0). Rates of intraoperative blood transfusion and postoperative intraabdominal problems were secondary outcomes. To produce summary estimates, random-effects models were utilized. For dichotomous outcomes, relative risk (RR) was employed as a summary measure, with matching 95% confidence intervals (CIs) for the primary outcome and 99% CIs after Bonferroni correction for the secondary outcomes.

The findings of this study were as follow:

1. Seven randomized controlled trials with a total of 2398 patients were undertaken.

2. In Comparison to crystalloid intravascular volume replacement, HES intravascular volume replacement was not linked with an increased incidence of 30-day AKI.

3. This analysis, according to the TSA, was underpowered.

4. HES intravascular volume replacement was linked to more blood transfusions and similar rates of postoperative intraabdominal complications.

In conclusion, this systematic review and meta-analysis show that HES intravascular volume replacement was not related to a greater risk of 30-day AKI when compared to crystalloid intravascular volume replacement, despite the lack of a large enough sample size to conclude with certainty. The CI and TSA do not rule out the possibility of HES intravascular volume replacement having a negative impact on renal function.

Reference:

Pensier, J., Deffontis, L., Rollé, A., Aarab, Y., Capdevila, M., Monet, C., Carr, J., Futier, E., Molinari, N., Jaber, S., & De Jong, A. (2021). Hydroxyethyl Starch for Fluid Management in Patients Undergoing Major Abdominal Surgery: A Systematic Review With Meta-analysis and Trial Sequential Analysis. In Anesthesia & Analgesia (Vol. 134, Issue 4, pp. 686–695). Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1213/ane.0000000000005803

Keywords: abdominal surgery, hydroxyethyl starch, fluid management, kidney injury, crystalloid, blood transfusion, anesthesia, analgesia, Joris Pensier