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A Randomized, Controlled, Double-Blind Crossover Study on the Effects of 1-L Infusions of 6% Hydroxyethyl Starch Suspended in 0.9% Saline (Voluven) and a Balanced Solution (Plasma Volume Redibag) on Blood Volume, Renal Blood Flow Velocity, and Renal Cortical Tissue Perfusion in Healthy Volunteers

Chowdhury, Abeed H. BSc, MRCS*; Cox, Eleanor F. PhD; Francis, Susan T. PhD; Lobo, Dileep N. DM, FRCS, FACS*

doi: 10.1097/SLA.0000000000000324
Randomized Controlled Trials

Objective: We compared the effects of intravenous administration of 6% hydroxyethyl starch (maize-derived) in 0.9% saline (Voluven; Fresenius Kabi, Runcorn, United Kingdom) and a “balanced” preparation of 6% hydroxyethyl starch (potato-derived) [Plasma Volume Redibag (PVR); Baxter Healthcare, Thetford, United Kingdom] on renal blood flow velocity and renal cortical tissue perfusion in humans using magnetic resonance imaging.

Background: Hyperchloremia resulting from 0.9% saline infusion may adversely affect renal hemodynamics when compared with balanced crystalloids. This phenomenon has not been studied with colloids.

Methods: Twelve healthy adult male subjects received 1-L intravenous infusions of Voluven or PVR over 30 minutes in a randomized, double-blind manner, with crossover studies 7 to 10 days later. Magnetic resonance imaging proceeded for 60 minutes after commencement of infusion to measure renal artery blood flow velocity and renal cortical perfusion. Blood was sampled, and weight was recorded at 0, 30, 60, 120, 180, and 240 minutes.

Results: Mean peak serum chloride concentrations were 108 and 106 mmol/L, respectively, after Voluven and PVR infusion (P = 0.032). Changes in blood volume (P = 0.867), strong ion difference (P = 0.219), and mean renal artery flow velocity (P = 0.319) were similar. However, there was a significant increase in mean renal cortical tissue perfusion after PVR when compared with Voluven (P = 0.033). There was no difference in urinary neutrophil gelatinase–associated liopcalin to creatinine ratios after the infusion (P = 0.164).

Conclusions: There was no difference in the blood volume–expanding properties of the 2 preparations of 6% hydroxyethyl starch. The balanced starch produced an increase in renal cortical tissue perfusion, a phenomenon not seen with starch in 0.9% saline.

This randomized crossover study in healthy subjects showed no differences in the blood volume–expanding properties of 6% hydroxyethyl starch suspended in a balanced solution or 0.9% saline. Hyperchloremia occurred with the latter. The former produced an increase in renal cortical tissue perfusion, a phenomenon not seen with the latter.

*Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom; and

Sir Peter Mansfield Magnetic Resonance Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, United Kingdom.

Reprints: Dileep N. Lobo, DM, FRCS, FACS, Division of Gastrointestinal Surgery, Nottingham University Hospitals, Queen's Medical Centre, Nottingham NG7 2UH, United Kingdom. E-mail: dileep.lobo@nottingham.ac.uk.

Disclosure: A.H.C. received research fellowships from the Royal College of Surgeons of England and the Nottingham Digestive Diseases Centre National Institute for Health Research Biomedical Research Unit. The running costs of this investigator-initiated study were met by a grant from Baxter Healthcare Corporation. The sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, or in the writing of the report. A.H.C. received a travel grant from Baxter Healthcare Corporation to present the data. D.N.L. has received unrestricted research funding, travel grants, and speaker's honoraria from Baxter Healthcare Corporation, Fresenius Kabi, and B. Braun. E.F.C. and S.T.F. have no conflicts of interest to declare. Preliminary data were presented at the International Surgical Congress of the Association of Surgeons of Great Britain and Ireland, Bournemouth, May 2011, and at the Annual Congress of the European Society for Clinical Nutrition and Metabolism, Gothenburg, September 2011. The article has been published in abstract form: Br J Surg 2011;98:57 and Clin Nutr Suppl 2011;6:23.

© 2014 by Lippincott Williams & Wilkins.