Impact of perioperative administration of 6 % hydroxyethyl starch 130/0.4 on serum cystatin C-derived renal function after radical prostatectomy: a single-centre retrospective study

Stefan Südfeld, Sami R Leyh-Bannurah, Lars Budäus, Markus Graefen, Philip C Reese, Franziska von Breunig, Daniel A Reuter, Bernd Saugel, Stefan Südfeld, Sami R Leyh-Bannurah, Lars Budäus, Markus Graefen, Philip C Reese, Franziska von Breunig, Daniel A Reuter, Bernd Saugel

Abstract

Background: Hydroxyethyl starch (HES) is used for repletion of acute intravasal volume loss in surgical patients. However, in critically ill patients, HES is associated with acute kidney injury. We aimed to evaluate the effect of HES on perioperative cystatin C (cystC)-derived estimated glomerular filtration rates (eGFRcystC) in patients undergoing open and robot-assisted radical prostatectomy.

Methods: In this retrospective study we included 179 patients who underwent general anaesthesia for radical prostatectomy received HES perioperatively, and had complete cystC and fluid therapy data available. CystC and corresponding eGFRcystC at postoperative days 1, 3, and 5 were compared with preoperative baseline using Wilcox rank-sum test.

Results: In 179 eligible patients, 6 % HES 130/0.4 was administered in a median (25th to 75th percentile) dose of 1000 mL (1000 to 1000 mL). Baseline eGFRcystC was 109.4 mL/min (100.3 to 118.7 mL/min). eGFRcystC on postoperative days 1, 3, and 5 was 120.4 mL/min (109.4 to 134.0 mL/min), 120.4 mL/min (109.4 to 132.9 mL/min), and 117.9 mL/min (106.6 to 129.8 mL/min), respectively (p < 0.001 compared with baseline, each). No patient had an eGFRcystC-decrease of ≥25 % from baseline.

Conclusions: The results indicate that the administration of a median dose of 1000 mL of 6 % HES 130/0.4 is not associated with a postoperative deterioration of renal function in patients with normal to near-normal baseline renal function undergoing radical prostatectomy.

Keywords: Acute kidney injury; Anesthesia; Kidney function tests; Perioperative period.

Figures

Fig. 1
Fig. 1
Patient flow diagram. Illustration of patient exclusion
Fig. 2
Fig. 2
Box-whisker-plots on perioperative renal function. Illustration of the course of peri-operative a serum cystatin C concentration (cystC) and b corresponding cystC-derived estimated glomerular filtration rate (eGFRcystC) in patients undergoing radical prostatectomy (open or robot-assisted). N = 179. Wilcox signed rank test: p < 0.001 for baseline vs. day 1, day 3, day 5, each
Fig. 3
Fig. 3
Frequencies of perioperative renal function deterioration. Frequency of maximum perioperative a serum Cystatin C (cystC)-increase and b cystC-derived estimated glomerular filtration rate (eGFRcystC)-decrease in patients undergoing radical prostatectomy (open or robot-assisted) on postoperative days 1, 3 or 5. N = 179

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