Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

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

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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.

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 (2−1.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.

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.

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.


Hydroxyethyl Starch Derivatives;  Hysterectomy;  Kidney function tests


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.


Derivados de Amido Hidroxietílico; Histerectomia; Testes de função renal


1 C Boer, SM Bossers, NJ. Koning Choice of fluid type: physiological concepts and perioperative indications Br J Anaesth, 120 (2018), pp. 384-396

2 B Plumb, J. Brown Fluid therapy for anaesthetists and intensivists Anaesth Intensive Care Med, 16 (2015), pp. 439-442

3 JM Calvo-Vecino, J Ripollés-Melchor, MG Mythen, et al. Effect of goal-directed haemodynamic therapy on postoperative complications in low–moderate risk surgical patients: a multicentre randomised controlled trial (FEDORA trial) Br J Anaesth, 120 (2018), pp. 734-744

4 M Doherty, DJ. Buggy Intraoperative fluids: how much is too much? Br J Anaesth, 109 (2012), pp. 69-79

5 LHC Navarro, JA Bloomstone, JOC Auler, et al. Perioperative fluid therapy: a statement from the international Fluid Optimization Group Perioper Med, 4 (2015), p. 3

6 PBB Schol, IM Terink, MD Lancé, et al. Liberal or restrictive fluid management during elective surgery: a systematic review and meta-analysis J Clin Anesth, 35 (2016), pp. 26-39

7 MS Strunden, S Tank, T. Kerner Perioperative fluid therapy: defining a clinical algorithm between insufficient and excessive J Clin Anesth, 35 (2016), pp. 384-391

8 R McCahon, J. Hardman Pharmacology of plasma expanders Anaesth Intensive Care Med, 18 (2017), pp. 418-420

9 N Drury, A. Lewington Prevention and management of acute kidney injury in the perioperative patient Surgery, 36 (2018), pp. 705-709

10 SD Gumbert, F Kork, ML Jackson, et al. Perioperative acute kidney injury Anesthesiology, 132 (2020), pp. 180-204

11 SH Teo, ZH. Endre Biomarkers in acute kidney injury (AKI) Best Pract Res Clin Anaesthesiol, 31 (2017), pp. 331-344

12 J Vanmassenhove, R Vanholder, E Nagler, et al. Urinary and serum biomarkers for the diagnosis of acute kidney injury: An in-depth review of the literature Nephrol Dial Transplant, 28 (2013), pp. 254-273

13 WM Michels, DC Grootendorst, M Verduijn, et al. Performance of the Cockcroft-Gault, MDRD, and new CKD-EPI formulas in relation to GFR, age, and body size Clin J Am Soc Nephrol, 5 (2010), pp. 1003-1009

14 SR Lewis, MW Pritchard, DJW Evans, et al. Colloids versus crystalloids for fluid resuscitation in critically ill people Cochrane Database Syst Rev, 8 (8) (2018), Article CD000567

15 R Claure-Del Granado, RL. Mehta Fluid overload in the ICU: evaluation and management BMC Nephrology, 17 (2016), pp. 1-9

16 C Lane, M Brown, W Dunsmuir, J Kelly, G. Mangos Can spot urine protein/creatinine ratio replace 24 h urine protein in usual clinical nephrology? Nephrology, 11 (2006), pp. 245-249

17 ASP Kancir, JK Johansen, NP Ekeloef, et al. The effect of 6% hydroxyethyl starch 130/0.4 on renal function, arterial blood pressure, and vasoactive hormones during radical prostatectomy: a randomized controlled trial Anesth Analg, 120 (2015), pp. 608-618

18 ASP Kancir, L Pleckaitiene, TB Hansen, et al. Lack of nephrotoxicity by 6% hydroxyethyl starch 130/0.4 during hip arthroplasty: a randomized controlled trial Anesthesiology, 121 (2014), pp. 948-958

19 A Tyagi, G Verma, A Luthra, et al. Risk of early postoperative acute kidney injury with stroke volume variation-guided tetrastarch versus Ringer's lactate Saudi J Anaesth, 13 (2019), pp. 9-15

20 Y Zhang, Y Yu, J Jia, et al. Administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury BMC Anesthesiol, 17 (2017), p. 29

21 A Feldheiser, V Pavlova, T Bonomo, et al. Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm Br J Anaesth, 110 (2013), pp. 231-240

22 A Joosten, A Delaporte, J Mortier, et al. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery Anesthesiology, 130 (2019), pp. 227-236

23 M Nishimoto, M Murashima, M Kokubu, et al. Positive association between intra-operative fluid balance and post-operative acute kidney injury in non-cardiac surgery: the NARA-AKI cohort study J Nephrol, 33 (2020), pp. 561-568

24 JA Myburgh, S Finfer, R Bellomo, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care N Engl J Med, 367 (2012), pp. 1901-1911

25 A Perner, N Haase, AB Guttormsen, et al. Hydroxyethyl starch 130/0.42 versus ringer's acetate in severe sepsis N Engl J Med, 367 (2012), pp. 124-134

26 B Kabon, DI Sessler, A Kurz, et al. Effect of intraoperative goal-directed balanced crystalloid versus colloid administration on major postoperative morbidity Anesthesiology, 130 (2019), pp. 728-744

27 A Joosten, A Delaporte, J Mortier, et al. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery Anesthesiology, 130 (2019), pp. 227-236

28 KC Rasmussen, PI Johansson, M Højskov, et al. Hydroxyethyl starch reduces coagulation competence and increases blood loss during major surgery: results from a randomized controlled trial Ann Surg, 259 (2014), pp. 249-254

29 I Roberts, H Shakur, R Bellomo, et al. Hydroxyethyl starch solutions and patient harm Lancet, 391 (2018), p. 736

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