J Korean Med Sci.  2020 Oct;35(40):e325. 10.3346/jkms.2020.35.e325.

Lack of Association between Low Cumulative Dose of Hydroxyethyl Starch and Acute Kidney Injury in Patients with Acute Ischemic Stroke

• Park SH
• Kim TJ
• Jeong HB
• Ko SB

• KMID: 2507615
• DOI: http://doi.org/10.3346/jkms.2020.35.e325

Abstract

Background
Hydroxyethyl starch (HES, 6% 130/0.4) has been used as a volume expander for the treatment of cerebral hypoperfusion in acute ischemic stroke. Although HES use was associated with renal failure in sepsis or critical illness, it still remains to be elucidated whether HES is linked to renal adverse events in patients with acute ischemic stroke.
Methods
A total of 524 patients with acute ischemic stroke within 7 days of onset were included between January 2012 and May 2016. Renal function on admission and follow-up on day 7 ± 2 was assessed using serum creatinine (SCr) and estimated glomerular filtration rate (eGFR). Propensity score matching (PSM) was used to perform a 1:1 matched-pair analysis to minimize the group differences caused by covariates. The percentage of patients with newonset acute renal injury (AKI) using the Kidney Disease: Improving Global Outcomes or good functional outcome (modified Rankin Scale 0–2) at 90 days were compared between HES cohort and controls.
Results
Among the included patients (mean age, 68.6 years; male, 56.5%), 81 patients (15.5%) were HES cohort (median cumulative dose, 1,450 mL). Baseline renal function was better in HES cohort compared to that in the controls (SCr, 0.87 ± 0.43 mg/dL vs. 1.15 ± 1.15 mg/dL, P < 0.001; eGFR, 86.91 ± 24.27 mL/min vs. 74.55 ± 29.58 mL/min, P < 0.001), which became not significant in PSM cohort (72 pairs). The percentage of new-onset AKI did not differ between the HES cohort and controls (1.4% vs. 1.4%, P = 1.000). In addition, newonset AKI was not related to HES (odds ratio, 1.422; 95% confidence interval, 0.072–28.068; P = 0.817) after adjusting for confounders. HES cohort tended to have higher percentage of good functional outcome at 90 days compared to controls, which failed to reach statistical significance (68.1% vs. 54.2%, P = 0.087).
Conclusion
A low cumulative dose of HES was not associated with renal adverse events in patients with acute ischemic stroke.

Keyword

Hydroxyethyl Starch; Acute Kidney Injury; Acute Ischemic Stroke

Figure

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  Fig. 1 Flow diagram of patients selection.HES = hydroxyethyl starch, mRS = modified Rankin Scale.

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  Fig. 2 The change of SCr and eGFR between HES cohorts and controls. (A) The initial and follow-up levels of SCr and (B) eGFR were not different between the two groups.HES = hydroxyethyl starch, SCr = serum creatinine, eGFR = estimated glomerular filtration rate.

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