Infusion of 7.2% NaCl/6% Hydroxyethyl Starch 200/0.5 in On-Pump Coronary Artery Bypass Surgery Patients: A Randomized, Single-Blind Pilot Study

BACKGROUND:

NaCl 7.2%/6% hydroxyethyl starch
(HES) 200/0.5 (HSH) has shown its beneficial effects in cardiac surgery
and immunomodulatory values in experiment and human studies. However,
there is concern regarding detrimental renal effects of chloride and HES
in the intensive care setting.

OBJECTIVES:

The objective
of this study was to evaluate the influence of HSH on kidney integrity
and the level of inflammatory mediators in on-pump coronary artery
bypass surgery patients.

DESIGN:

This was a
single-center, prospective, randomized, single-blind pilot study.
Setting: This work was performed at a tertiary cardiothoracic referral
center during the period from February to August 2012. Patients: Forty
patients scheduled for on-pump coronary artery bypass surgery were
included.

INTERVENTIONS:

Patients were randomized to
receive once either 7.2% NaCl/6% HES 200/0.5 (HSH group, n = 20) or
placebo (0.9% NaCl; control group, n = 20) at a dose of 4 mL·kg for 30
min after anesthesia induction. Main outcome measures: The primary end
point was the incidence of acute kidney injury (AKI) defined according
to the Kidney Disease: Improving Global Outcomes. Secondary end points
were peak serum cystatin C, peak urine neutrophil gelatinase-associated
lipocalin, plasma levels of interleukin 6 (IL-6), IL-10, intercellular
adhesion molecule 1, and endothelial-leukocyte adhesion molecule
(E-selectin). Results: The incidence of AKI within 48 h was similar
between the groups (HSH: four patients [20%]; control: six patients
[30%]). There was a significantly lower peak value for serum cystatin C
in the HSH group (0.83 [0.73-0.89] mg·L) compared with the control group
(1.02 [0.88-1.15] mg·L; P = 0.001). Patients in both groups had similar
peak postoperative urine neutrophil gelatinase-associated lipocalin
concentrations. NaCl 7.2%/6% hydroxyethyl starch 200/0.5 significantly
reduces levels of IL-6 and IL-10 at 4 h after cardiopulmonary bypass and
intercellular adhesion molecule 1 and E-selectin at 4 h after
cardiopulmonary bypass and on postoperative day 1 (P < 0.05 for all).

CONCLUSIONS:

NaCl
7.2%/6% hydroxyethyl starch 200/0.5 does not lead to the increase in
AKI incidence when used for the volume therapy in on-pump coronary
artery bypass surgery patients. NaCl 7.2%/6% hydroxyethyl starch 200/0.5
usage enhanced neither tubular injury nor alteration of glomerular
filtration. In addition, HSH can reduce the level of the inflammatory
mediators after surgery.