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

Rajika Tobey, Hao Cheng, Mei Gao, Zhongmin Li, J Nilas Young, Walter D Boyd, Fuhai Ji, Hong Liu

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives This study assessed the effect of 2 types of hydroxyethyl starches (HES) on renal integrity and blood transfusion in cardiac surgery patients. Design Retrospective investigation. Setting Patients from a single tertiary medical center. Participants Inclusion criteria included coronary artery bypass graft (CABG) and/or valve surgery that included cardiopulmonary bypass with aortic cross-clamping. Interventions Intraoperative HES and blood product administration. Measurements and Main Results The study comprised 1,265 patients who met inclusion criteria. Of these patients, 70% received HES, and of these, 47% received<1,000 mL and 53% received≥1,000 mL. There was no difference in the development of acute kidney injury between the 2 groups. A parsimonious propensity model for colloids showed that combined CABG and valve surgery were less likely to be associated with HES administration than was CABG alone (OR 0.68, confidence interval [CI] 0.46-0.97; p = 0.04). Intra-aortic balloon pump use was less likely to be associated with HES administration (OR 0.57, CI 0.38-0.86; p = 0.007). Patients with chronic kidney disease, stages 3 to 5, were less likely to receive HES, with an OR of 0.56 (CI 0.38-0.84; p = 0.004); 0.51 (CI 0.20-1.33; p = 0.170); and 0.23 (CI 0.12-0.44; p<0.0001), respectively, for each stage. No difference was noted in red blood cell transfusion. However, fresh frozen plasma, cryoprecipitate, and platelet transfusions were significantly higher with larger volumes of HES, with an OR of 2.03 (CI 1.64-2.52; p<0.001); 1.60 (CI 1.30-1.97; p<0.000); and 1.62 (CI 1.21-2.15; p = 0.006), respectively. No differences in surgical mortality were found between the colloid and noncolloid groups. Conclusions This study showed no association of postoperative acute kidney injury and red blood cell transfusion between the colloid and noncolloid groups. Although the complication rate was higher with HES administration, there was no difference in surgery mortality between the 2 groups.

Original languageEnglish (US)
Pages (from-to)853-862
Number of pages10
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume31
Issue number3
DOIs
StatePublished - Jun 1 2017

Fingerprint

Colloids
Acute Kidney Injury
Blood Transfusion
Thoracic Surgery
Starch
Confidence Intervals
Coronary Artery Bypass
Erythrocyte Transfusion
Transplants
Hydroxyethyl Starch Derivatives
Platelet Transfusion
Mortality
Cardiopulmonary Bypass
Chronic Renal Insufficiency
Constriction
Kidney

Keywords

  • acute kidney injury
  • blood products
  • cardiopulmonary bypass
  • hydroxyethyl starch
  • synthetic colloid

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery. / Tobey, Rajika; Cheng, Hao; Gao, Mei; Li, Zhongmin; Young, J Nilas; Boyd, Walter D; Ji, Fuhai; Liu, Hong.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 31, No. 3, 01.06.2017, p. 853-862.

Research output: Contribution to journalArticle

@article{df8788b24ab2487bbce78817d0a3c698,
title = "Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery",
abstract = "Objectives This study assessed the effect of 2 types of hydroxyethyl starches (HES) on renal integrity and blood transfusion in cardiac surgery patients. Design Retrospective investigation. Setting Patients from a single tertiary medical center. Participants Inclusion criteria included coronary artery bypass graft (CABG) and/or valve surgery that included cardiopulmonary bypass with aortic cross-clamping. Interventions Intraoperative HES and blood product administration. Measurements and Main Results The study comprised 1,265 patients who met inclusion criteria. Of these patients, 70{\%} received HES, and of these, 47{\%} received<1,000 mL and 53{\%} received≥1,000 mL. There was no difference in the development of acute kidney injury between the 2 groups. A parsimonious propensity model for colloids showed that combined CABG and valve surgery were less likely to be associated with HES administration than was CABG alone (OR 0.68, confidence interval [CI] 0.46-0.97; p = 0.04). Intra-aortic balloon pump use was less likely to be associated with HES administration (OR 0.57, CI 0.38-0.86; p = 0.007). Patients with chronic kidney disease, stages 3 to 5, were less likely to receive HES, with an OR of 0.56 (CI 0.38-0.84; p = 0.004); 0.51 (CI 0.20-1.33; p = 0.170); and 0.23 (CI 0.12-0.44; p<0.0001), respectively, for each stage. No difference was noted in red blood cell transfusion. However, fresh frozen plasma, cryoprecipitate, and platelet transfusions were significantly higher with larger volumes of HES, with an OR of 2.03 (CI 1.64-2.52; p<0.001); 1.60 (CI 1.30-1.97; p<0.000); and 1.62 (CI 1.21-2.15; p = 0.006), respectively. No differences in surgical mortality were found between the colloid and noncolloid groups. Conclusions This study showed no association of postoperative acute kidney injury and red blood cell transfusion between the colloid and noncolloid groups. Although the complication rate was higher with HES administration, there was no difference in surgery mortality between the 2 groups.",
keywords = "acute kidney injury, blood products, cardiopulmonary bypass, hydroxyethyl starch, synthetic colloid",
author = "Rajika Tobey and Hao Cheng and Mei Gao and Zhongmin Li and Young, {J Nilas} and Boyd, {Walter D} and Fuhai Ji and Hong Liu",
year = "2017",
month = "6",
day = "1",
doi = "10.1053/j.jvca.2016.12.024",
language = "English (US)",
volume = "31",
pages = "853--862",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Postoperative Acute Kidney Injury and Blood Product Transfusion After Synthetic Colloid Use During Cardiac Surgery

AU - Tobey, Rajika

AU - Cheng, Hao

AU - Gao, Mei

AU - Li, Zhongmin

AU - Young, J Nilas

AU - Boyd, Walter D

AU - Ji, Fuhai

AU - Liu, Hong

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objectives This study assessed the effect of 2 types of hydroxyethyl starches (HES) on renal integrity and blood transfusion in cardiac surgery patients. Design Retrospective investigation. Setting Patients from a single tertiary medical center. Participants Inclusion criteria included coronary artery bypass graft (CABG) and/or valve surgery that included cardiopulmonary bypass with aortic cross-clamping. Interventions Intraoperative HES and blood product administration. Measurements and Main Results The study comprised 1,265 patients who met inclusion criteria. Of these patients, 70% received HES, and of these, 47% received<1,000 mL and 53% received≥1,000 mL. There was no difference in the development of acute kidney injury between the 2 groups. A parsimonious propensity model for colloids showed that combined CABG and valve surgery were less likely to be associated with HES administration than was CABG alone (OR 0.68, confidence interval [CI] 0.46-0.97; p = 0.04). Intra-aortic balloon pump use was less likely to be associated with HES administration (OR 0.57, CI 0.38-0.86; p = 0.007). Patients with chronic kidney disease, stages 3 to 5, were less likely to receive HES, with an OR of 0.56 (CI 0.38-0.84; p = 0.004); 0.51 (CI 0.20-1.33; p = 0.170); and 0.23 (CI 0.12-0.44; p<0.0001), respectively, for each stage. No difference was noted in red blood cell transfusion. However, fresh frozen plasma, cryoprecipitate, and platelet transfusions were significantly higher with larger volumes of HES, with an OR of 2.03 (CI 1.64-2.52; p<0.001); 1.60 (CI 1.30-1.97; p<0.000); and 1.62 (CI 1.21-2.15; p = 0.006), respectively. No differences in surgical mortality were found between the colloid and noncolloid groups. Conclusions This study showed no association of postoperative acute kidney injury and red blood cell transfusion between the colloid and noncolloid groups. Although the complication rate was higher with HES administration, there was no difference in surgery mortality between the 2 groups.

AB - Objectives This study assessed the effect of 2 types of hydroxyethyl starches (HES) on renal integrity and blood transfusion in cardiac surgery patients. Design Retrospective investigation. Setting Patients from a single tertiary medical center. Participants Inclusion criteria included coronary artery bypass graft (CABG) and/or valve surgery that included cardiopulmonary bypass with aortic cross-clamping. Interventions Intraoperative HES and blood product administration. Measurements and Main Results The study comprised 1,265 patients who met inclusion criteria. Of these patients, 70% received HES, and of these, 47% received<1,000 mL and 53% received≥1,000 mL. There was no difference in the development of acute kidney injury between the 2 groups. A parsimonious propensity model for colloids showed that combined CABG and valve surgery were less likely to be associated with HES administration than was CABG alone (OR 0.68, confidence interval [CI] 0.46-0.97; p = 0.04). Intra-aortic balloon pump use was less likely to be associated with HES administration (OR 0.57, CI 0.38-0.86; p = 0.007). Patients with chronic kidney disease, stages 3 to 5, were less likely to receive HES, with an OR of 0.56 (CI 0.38-0.84; p = 0.004); 0.51 (CI 0.20-1.33; p = 0.170); and 0.23 (CI 0.12-0.44; p<0.0001), respectively, for each stage. No difference was noted in red blood cell transfusion. However, fresh frozen plasma, cryoprecipitate, and platelet transfusions were significantly higher with larger volumes of HES, with an OR of 2.03 (CI 1.64-2.52; p<0.001); 1.60 (CI 1.30-1.97; p<0.000); and 1.62 (CI 1.21-2.15; p = 0.006), respectively. No differences in surgical mortality were found between the colloid and noncolloid groups. Conclusions This study showed no association of postoperative acute kidney injury and red blood cell transfusion between the colloid and noncolloid groups. Although the complication rate was higher with HES administration, there was no difference in surgery mortality between the 2 groups.

KW - acute kidney injury

KW - blood products

KW - cardiopulmonary bypass

KW - hydroxyethyl starch

KW - synthetic colloid

UR - http://www.scopus.com/inward/record.url?scp=85019669830&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019669830&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2016.12.024

DO - 10.1053/j.jvca.2016.12.024

M3 - Article

C2 - 28302346

AN - SCOPUS:85019669830

VL - 31

SP - 853

EP - 862

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 3

ER -