Newly Published
Perioperative Medicine  |   November 2018
Long-term Impact of Crystalloid versus Colloid Solutions on Renal Function and Disability-free Survival after Major Abdominal Surgery
Author Notes
  • From the Departments of Anesthesiology (A.J., A.D., J.M., B.I., L.V.O.) and Intensive Care (J.L.V.), CUB Erasme and the Department of Anesthesiology, Brugmann Hospital (P.V.d.L.), Université Libre de Bruxelles, Bruxelles, Belgium; the Department of Anesthesiology and Intensive Care, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Université Paris-Saclay, Hôpital De Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France (A.J.); the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (M.C.); and the Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange County, California (J.R.).
  • A.J. and A.D. contributed equally to this article.
    A.J. and A.D. contributed equally to this article.×
  • Submitted for publication April 14, 2018. Accepted for publication October 2, 2018.
    Submitted for publication April 14, 2018. Accepted for publication October 2, 2018.×
  • Correspondence: Address correspondence to Dr. Joosten: Erasme Hospital, 808 Route de Lennik, 1070 Bruxelles, Belgium. alexandre.joosten@erasme.ulb.ac.be. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   November 2018
Long-term Impact of Crystalloid versus Colloid Solutions on Renal Function and Disability-free Survival after Major Abdominal Surgery
Anesthesiology Newly Published on November 9, 2018. doi:10.1097/ALN.0000000000002501
Anesthesiology Newly Published on November 9, 2018. doi:10.1097/ALN.0000000000002501
Abstract

What We Already Know about This Topic:

  • Balanced hydroxyethyl starch solution, as part of intraoperative goal-directed fluid therapy, is associated with better short-term outcomes than administration of a balanced crystalloid solution in patients having major open abdominal surgery

  • The safety of modern hydroxyethyl starch solutions remains debated, with some studies in the intensive care setting have reported potential nephrotoxic effects, while others, performed in a surgical context, have not

What This Article Tells Us That Is New:

  • In a long-term follow-up of a previous trial comparing hydroxyethyl starch solution and balanced crystalloid used as part of intraoperative goal directed fluid therapy in patients undergoing major open abdominal surgery, there was no evidence that one therapy had superior renal function; however, limited power tempers any ability to completely rule out a difference

  • Disability-free survival was higher in the colloid than in the crystalloid group

Background: The authors recently demonstrated that administration of balanced hydroxyethyl starch solution as part of intraoperative goal-directed fluid therapy was associated with better short-term outcomes than administration of a balanced crystalloid solution in patients having major open abdominal surgery. In the present study, a 1-yr follow-up of renal and disability outcomes in these patients was performed.

Methods: All patients enrolled in the earlier study were followed up 1 yr after surgery for renal function and disability using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The main outcome measure was the estimated glomerular filtration rate. Other outcomes were serum creatinine, urea, pruritus, and WHODAS score. Groups were compared on a complete-case analysis basis, and modern imputation methods were then used in mixed-model regressions to assess the stability of the findings taking into account the missing data.

Results: Of the 160 patients enrolled in the original study, follow-up data were obtained for renal function in 129 and for WHODAS score in 114. There were no statistically significant differences in estimated glomerular filtration rate at 1 yr (ml min−1 1.73 m−2): 80 [65 to 92] for crystalloids versus 74 [64 to 94] for colloids; 95% CI [−10 to 7], P = 0.624. However, the WHODAS score (%) was statistically significantly lower in the colloid than in the crystalloid group (2.7 [0 to 12] vs. 7.6 [1.3 to 18]; P = 0.015), and disability-free survival was higher (79% vs. 60%; 95% CI [2 to 39]; P = 0.024).

Conclusions: In patients undergoing major open abdominal surgery, there was no evidence of a statistically significant difference in long-term renal function between a balanced hydroxyethyl starch and a balanced crystalloid solution used as part of intraoperative goal-directed fluid therapy, although there was only limited power to rule out a clinically significant difference. However, disability-free survival was significantly higher in the colloid than in the crystalloid group.