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Pentastarch 10% (250 kDa/0.45) is an independent risk factor of acute kidney injury following cardiac surgery*

Rioux, Jean-Philippe MD; Lessard, Myriam MD; De Bortoli, Bruno MD; Roy, Patrick MSc; Albert, Martin MD; Verdant, Colin MD; Madore, François MD, MSc; Troyanov, Stéphan MD

doi: 10.1097/CCM.0b013e31819cc1a0
Clinical Investigations

Objective, Design and Patients: The risk of acute kidney injury (AKI) associated with hydroxyethyl starch may be limited to higher molecular weight agents. We retrospectively evaluated the risk of AKI using pentastarch 10% (250 kDa, 0.45) in a random cohort of 563 patients operated for a cardiac surgery at a university hospital.

Measures: We assessed previously identified preoperative, perioperative, and postoperative risk factors, and the volume of pentastarch given until the end of the first postoperative day. We defined AKI by a 50% rise in serum creatinine within 4 days after surgery. Different propensity adjustment methods were used to further assess the selection bias.

Results: Fifty-four (10%) patients developed AKI. Risk factors of AKI were age, female gender, preoperative creatinine clearance, hypertension, diuretic use, left ventricular ejection fraction, valvular surgery, duration of extracorporeal circulation, duration and dose of postoperative vasopressor support, and the number of red blood cells and fresh frozen plasma transfusions. Patients with AKI received 16 ± 9 mL/kg of pentastarch as opposed to 10 ± 7 mL/kg in controls (p < 0.001). Pentastarch remained independently predictive of AKI, with an adjusted odds ratio per mL/kg of 1.08 (95% confidence interval 1.04–1.12, p = 0.001). This risk was dose-dependent, and the optimal cutoff volume predicting AKI was 14 mL/kg. Different propensity adjustment methods were tested, and pentastarch as a risk factor of AKI was identified.

Conclusions: This study identified a dose-dependent risk of AKI with pentastarch following cardiac surgery, given until the end of the first postoperative day.

From the Divisions of Nephrology (J-PR, ML, BDB, PR, FM, ST) and Intensive Care (MA, CV), Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.

Drs. Troyanov, Verdant, and Madore’s research efforts are supported by the Fonds de la Recherche en Santé du Québec.

The authors had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the analysis. We have no conflict of interest to declare.

The authors have not disclosed any potential conflicts of interest.

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© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins