Renal effects of saline-based 10% pentastarch versus 6% tetrastarch infusion in ovine endotoxemic shock.

Abstract

BACKGROUND:

Conflicting data exist on the renal effects of hydroxyethyl starch (HES) preparations. The current study evaluates the effects of saline-based 6% HES 130/0.4, 10% HES 200/0.5, and a balanced isotonic crystalloid on renal function and microscopic changes in ovine endotoxemic shock.

METHODS:

Thirty sheep were subjected to endotoxin infusion (Salmonella typhosa) at incremental doses until mean arterial pressure was less than 65 mmHg. Animals were randomized to receive fluid resuscitation with saline-based 6% HES 130/0.4, 10% HES 200/0.5, or a balanced isotonic crystalloid (n = 10 each). Animals surviving the 12-h intervention period were anesthetized and killed. Kidney samples were taken for microscopic analyses.

RESULTS:

Endotoxemia was associated with hemoconcentration, protein extravasation, and arterial hypotension. Fluid resuscitation established a hypotensive-hyperdynamic circulation with increased cardiac index and oxygen delivery and decreased afterload. Diuresis was lowest in animals treated with 10% HES 200/0.5. In addition, plasma creatinine and urea concentrations increased in sheep treated with 10% HES 200/0.5 (1.2 +/- 0.1 and 19 +/- 2 mg/dl) when compared with the other two groups (0.9 +/- 0.1 and 15 +/- 1 mg/dl, 6% HES 130/0.4; 0.9 +/- 0.1 and 15 +/- 1 mg/dl, crystalloids; each P < 0.05). Electron microscopic tubular injury score was highest in sheep treated with 10% HES 200/0.5 (P < 0.001 vs. 6% HES 130/0.4).

CONCLUSIONS:

In ovine endotoxemic shock, saline-based 10% HES 200/0.5 was linked to impaired renal function and more pronounced tubular epithelial injury when compared with 6% HES 130/0.4 and balanced crystalloids.

• Authors: Christian Ertmer, Gabriele Köhler, Sebastian Rehberg, Andrea Morelli, Matthias Lange, Björn Ellger, Bernardo Bollen Pinto, Eva Rübig, Michael Erren, Lars G Fischer, Hugo Van Aken, Martin Westphal
• Journal: Anesthesiology (Anesthesiology) Vol. 112 Issue 4 Pg. 936-47 (Apr 2010) ISSN: 1528-1175 [Electronic] United States
• PMID: 20234306 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Endotoxins
• Hydroxyethyl Starch Derivatives
• Lipopolysaccharides
• Plasma Substitutes
• Proteins
• Urea
• Creatinine

Topics

• Animals
• Body Weight
• Creatinine (blood)
• Diuresis
• Endotoxemia (pathology)
• Endotoxins (toxicity)
• Female
• Hemodynamics (physiology)
• Hydroxyethyl Starch Derivatives (toxicity)
• Kidney (pathology, ultrastructure)
• Kidney Diseases (chemically induced, pathology)
• Kidney Function Tests
• Kidney Tubules (pathology)
• Lipopolysaccharides (toxicity)
• Microscopy, Electron
• Microscopy, Electron, Transmission
• Osmotic Pressure
• Oxygen Consumption (drug effects)
• Plasma Substitutes (toxicity)
• Proteins (metabolism)
• Renal Circulation (drug effects, physiology)
• Sheep
• Shock, Septic (pathology)
• Urea (blood)