Association between hydroxyethyl starch 130/0.4 administration during noncardiac surgery and postoperative acute kidney injury: A propensity score-matched analysis of a large cohort in China

Min-Jing Yang; Na Chen; Chun-Yan Ye; Qian Li; Hui Luo; Jing-Han Wu; Xing-Yang Liu; Qulian Guo; Daniel I Sessler; E Wang

doi:10.1016/j.jclinane.2024.111493

Association between hydroxyethyl starch 130/0.4 administration during noncardiac surgery and postoperative acute kidney injury: A propensity score-matched analysis of a large cohort in China

J Clin Anesth. 2024 May 8:96:111493. doi: 10.1016/j.jclinane.2024.111493. Online ahead of print.

Authors

Min-Jing Yang¹, Na Chen¹, Chun-Yan Ye¹, Qian Li¹, Hui Luo¹, Jing-Han Wu¹, Xing-Yang Liu¹, Qulian Guo¹, Daniel I Sessler², E Wang³

Affiliations

¹ Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China.
² Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Population Health Research Institute, McMaster University, ON, Canada.
³ Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China. Electronic address: ewang324@csu.edu.cn.

PMID: 38723416
DOI: 10.1016/j.jclinane.2024.111493

Abstract

Study objective: The use of hydroxyethyl starch 130/0.4 has been linked to renal injury in critically ill patients, but its impact on surgical patients remains uncertain.

Design: A retrospective cohort study.

Setting: This study was conducted at one tertiary care hospital in China.

Patients: We evaluated the records of 51,926 Chinese adults who underwent noncardiac surgery from 2013 to 2022. Patients given a combination of hydroxyethyl starch 130/0.4 and crystalloids were propensity-matched at a 1: 1 ratio of baseline characteristics to patients given only crystalloids (11,725 pairs).

Interventions: Eligible patients were divided into those given a combination of hydroxyethyl starch 130/0.4 and crystalloid during surgery and a reference crystalloid group consisting of patients who were not given any colloid.

Measurements: The primary outcome was the incidence of acute kidney injury. Secondarily, acute kidney injury stage, need for renal replacement therapy, intensive care unit transfer rate, and duration of postoperative hospitalization were considered.

Main results: After matching, hydroxyethyl starch use [8.5 (IQR: 7.5-10.0) mL/kg] did not increase the incidence of acute kidney injury compared with that in the crystalloid group [2.0 vs. 2.2%, OR: 0.90 (0.74-1.08), P = 0.25]. Nor did hydroxyethyl starch use worsen acute kidney injury stage [OR 0.90 (0.75-1.08), P = 0.26]. No significant differences between the fluid groups were observed in renal replacement therapy [OR 0.60 (0.41-0.90), P = 0.02)] or intensive care unit transfers [OR 1.02 (0.95-1.09), P = 0.53] after Bonferroni correction. Even in a subset of patients at high risk of renal injury, hydroxyethyl starch use was not associated with worse outcomes.

Conclusions: Hydroxyethyl starch 130/0.4 use was not significantly associated with a greater incidence of postoperative acute kidney injury compared to receiving crystalloid solutions only.

Keywords: Hydroxyethyl starch 130/0.4; Noncardiac surgery; Postoperative acute kidney injury.