Impact of colloids or crystalloids in renal function assessed by NGAL and KIM-1 after hysterectomy: randomized controlled trial
Impacto de coloides ou cristaloides na função renal avaliada por NGAL e KIM-1 após histerectomia: ensaio clínico randomizado
Murillo G. Santos, João Paulo Jordão Pontes, Saulo Gonçalves Filho, Rodrigo M. e Lima, Murilo M. Thom, Norma Sueli P. Módolo, Daniela Ponce, Lais Helena Navarro
Abstract
Background
Hydroxyethyl starches are colloids used in fluid therapy that may reduce volume infusion compared with crystalloids, but they can affect renal function in critical care patients. This study aims to assess renal effects of starches using renal biomarkers in the perioperative setting.
Methods
This prospective, controlled, randomized study compared Hydroxyethyl starch 6% (HES) with Ringer's lactate (RL) in hysterectomy. Each episode of mean arterial pressure (MAP) below 60 mmHg guided the fluid replacement protocol. The RL group received 300 mL bolus of RL solution while the HES group received 150 mL of HES solution. All patients received RL (2 mL.kg−1.h−1) intraoperatively to replace insensible losses. Blood and urine samples were collected at three time points (preoperatively, 24 hours, and 40 days postoperatively) to assess urinary NGAL and KIM-1, as primary outcome, and other markers of renal function.
Results
Seventy patients were randomized and 60 completed the study. The RL group received a higher crystalloid volume (1,277 ± 812.7 mL vs. 630.4 ± 310.2 mL; p = 0.0002) with a higher fluid balance (780 ± 720 mL vs. 430 ± 440 mL; p = 0.03) and fluid overload (11.7% ± 10.4% vs. 7.0% ± 6.3%; p = 0.04) compared to the HES group. NGAL and KIM-1 did not differ between groups at each time point, however both biomarkers increased 24 hours postoperatively and returned to preoperative levels after 40 days in both groups.
Conclusion
HES did not increase renal biomarkers following open hysterectomy compared to RL. Moreover, HES provided better hemodynamic parameters using less volume, and reduced postoperative fluid balance and fluid overload.
Keywords
Resumo
Justificativa: Os amidos hidroxietílicos são coloides usados na fluidoterapia que podem reduzir o volume de infusão em comparação com os cristaloides, mas podem afetar a função renal em pacientes críticos. Este estudo tem como objetivo avaliar os efeitos renais dos amidos usando biomarcadores renais no ambiente perioperatório. Métodos: Este estudo prospectivo, controlado e randomizado comparou o amido hidroxietílico 6% (HES) com o lactato de Ringer (LR) em histerectomia. Cada episódio de pressão arterial média (PAM) abaixo de 60 mmHg orientou o protocolo de reposição hídrica. O grupo RL recebeu bolus de 300 ml de solução RL enquanto o grupo HES recebeu 150 ml de solução de HES. Todos os pacientes receberam LR (2 ml/kg-1/h-1) no intraoperatório para repor perdas insensíveis. Amostras de sangue e urina foram coletadas em três momentos (pré-operatório, 24 horas e 40 dias de pós-operatório) para avaliar NGAL e KIM-1 urinários, como desfecho primário, e outros marcadores de função renal. Resultados: Setenta pacientes foram randomizados e 60 completaram o estudo. O grupo LR recebeu maior volume cristaloide (1.277 ± 812,7 ml vs. 630,4 ± 310,2 ml; p = 0,0002) com maior balanço hídrico (780 ± 720 ml vs. 430 ± 440 ml; p = 0,03) e sobrecarga hídrica (11,7 % ± 10,4% vs. 7,0% ± 6,3%; p = 0,04) em relação ao grupo HES. NGAL e KIM-1 não diferiram entre os grupos em cada momento, porém ambos os biomarcadores aumentaram 24 horas no pós-operatório e retornaram aos níveis pré-operatórios após 40 dias em ambos os grupos. Conclusão: HES não aumentou biomarcadores renais após histerectomia aberta em comparação com RL. Além disso, o HES forneceu melhores parâmetros hemodinâmicos usando menos volume e reduziu o equilíbrio hídrico pós-operatório e a sobrecarga hídrica.
Palavras-chave
References
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