|
1
|
Yang MJ, Chen N, Ye CY, Li Q, Luo H, Wu JH, Liu XY, Guo Q, Sessler DI, Wang E. Association between hydroxyethyl starch 130/0.4 administration during noncardiac surgery and postoperative acute kidney injury: A propensity score-matched analysis of a large cohort in China. J Clin Anesth 2024; 96:111493. [PMID: 38723416 DOI: 10.1016/j.jclinane.2024.111493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/18/2024] [Accepted: 05/02/2024] [Indexed: 06/16/2024]
Abstract
STUDY OBJECTIVE The use of hydroxyethyl starch 130/0.4 has been linked to renal injury in critically ill patients, but its impact on surgical patients remains uncertain. DESIGN A retrospective cohort study. SETTING This study was conducted at one tertiary care hospital in China. PATIENTS We evaluated the records of 51,926 Chinese adults who underwent noncardiac surgery from 2013 to 2022. Patients given a combination of hydroxyethyl starch 130/0.4 and crystalloids were propensity-matched at a 1: 1 ratio of baseline characteristics to patients given only crystalloids (11,725 pairs). INTERVENTIONS Eligible patients were divided into those given a combination of hydroxyethyl starch 130/0.4 and crystalloid during surgery and a reference crystalloid group consisting of patients who were not given any colloid. MEASUREMENTS The primary outcome was the incidence of acute kidney injury. Secondarily, acute kidney injury stage, need for renal replacement therapy, intensive care unit transfer rate, and duration of postoperative hospitalization were considered. MAIN RESULTS After matching, hydroxyethyl starch use [8.5 (IQR: 7.5-10.0) mL/kg] did not increase the incidence of acute kidney injury compared with that in the crystalloid group [2.0 vs. 2.2%, OR: 0.90 (0.74-1.08), P = 0.25]. Nor did hydroxyethyl starch use worsen acute kidney injury stage [OR 0.90 (0.75-1.08), P = 0.26]. No significant differences between the fluid groups were observed in renal replacement therapy [OR 0.60 (0.41-0.90), P = 0.02)] or intensive care unit transfers [OR 1.02 (0.95-1.09), P = 0.53] after Bonferroni correction. Even in a subset of patients at high risk of renal injury, hydroxyethyl starch use was not associated with worse outcomes. CONCLUSIONS Hydroxyethyl starch 130/0.4 use was not significantly associated with a greater incidence of postoperative acute kidney injury compared to receiving crystalloid solutions only.
Collapse
Affiliation(s)
- Min-Jing Yang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Na Chen
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Chun-Yan Ye
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Qian Li
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Hui Luo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Jing-Han Wu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Xing-Yang Liu
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Population Health Research Institute, McMaster University, ON, Canada
| | - E Wang
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, China; Clinical Research Center of Hunan Province for Anesthesia and Perioperative Medicine, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| |
Collapse
|
|
2
|
Chen Z, Tang L, Luo L, Luo W, Li Y, Wang X, Huang L, Hu Y, Mei H. Enhancing the Treatment of Uncontrolled Inflammation through the Targeted Delivery of TPCA-1-Loaded Nanoparticles. Pharmaceutics 2023; 15:2435. [PMID: 37896195 PMCID: PMC10609852 DOI: 10.3390/pharmaceutics15102435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Uncontrolled inflammation is a pathological state that underlies many diseases. Despite the development of numerous anti-inflammatory agents, the treatment of uncontrolled inflammation remains a challenging task. We developed a targeted delivery system for [5-(p-fluorophenyl)-2-ureido]thiophene-3-carboxamide (TPCA-1), a potent inhibitor of the NF-κB signaling pathway. The system comprises TPCA-1-loaded nanoparticles (NPs) functionalized with a monoclonal antibody (mAb) that specifically binds to the break point of the IgD6 region of the platelet/endothelial cell adhesion molecule-1 (PECAM-1) extracellular segment that is overexposed on the injured endothelium and activated macrophages during the pathogenesis of inflammation. In vitro binding and cellular uptake experiments revealed that the mAb modification on NPs could significantly enhance uptake by both Raw264.7 and HUVEC compared with unmodified NPs. In studies conducted at the cellular level focusing on anti-inflammatory and antioxidant effects, this formulation was found to effectively inhibit M1 polarization of macrophages, downregulate the secretion of pro-inflammatory cytokines, and reduce the production of reactive oxygen species (ROS) and nitric oxide (NO). In an animal model of vascular endothelial injury with acute inflammation, these NPs were capable of delivering TPCA-1 to inflammatory lesions in a targeted manner. Compared with the free agent-treated group, the NP-treated group exhibited reduced infiltration of inflammatory cells. In conclusion, our study demonstrates that this targeted delivery of TPCA-1-loaded NPs represents a promising strategy for improved mitigation of uncontrolled inflammation.
Collapse
Affiliation(s)
- Zhaozhao Chen
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Lu Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Lili Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Wenjing Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Yingying Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Xindi Wang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Linlin Huang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Z.C.); (L.T.); (L.L.); (W.L.); (Y.L.); (X.W.); (L.H.)
- Hubei Clinical Medical Center of Cell Therapy for Neoplastic Disease, Wuhan 430022, China
- Key Laboratory of Biological Targeted Therapy of Hubei Province, Wuhan 430022, China
| |
Collapse
|
|
3
|
Kopitkó C, Fülöp T, Tapolyai M, Gondos T. A Critical Reassessment of the Kidney Risk Caused by Tetrastarch Products in the Perioperative and Intensive Care Environments. J Clin Med 2023; 12:5262. [PMID: 37629303 PMCID: PMC10455866 DOI: 10.3390/jcm12165262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: The studies included in the former meta-analyses were scrutinized by the authors independently. We completed a critical analysis of the literature, including the strengths, weaknesses and modifiers of the studies when assessing products, formulations and outcomes. Results: Both the published large studies and meta-analyses show significant bias in the context of the deleterious effect of 6% 130/0.4-0.42 HES. Without (1) detailed hemodynamic data, (2) the exclusion of other nephrotoxic events and (3) a properly performed evaluation of the dose-effect relationship, the AKI-inducing property of 6% HES 130/0.4 or 0.42 should not be considered as evidence. The administration of HES is safe and effective if the recommended dose is respected. Conclusions: Our review suggests that there is questionable evidence for the deteriorating renal effect of these products. Further well-designed, randomized and controlled trials are needed. Additionally, conclusions formulated for resource-rich environments should not be extended to more resource-scarce environments without proper qualifiers provided.
Collapse
Affiliation(s)
- Csaba Kopitkó
- Department of Anesthesiology and Intensive Therapy, Uzsoki Teaching Hospital of Semmelweis University, Uzsoki u. 29–41, H-1145 Budapest, Hungary
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA
- Medicine Service, Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA;
| | - Mihály Tapolyai
- Medicine Service, Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA;
- Szent Margit Hospital, Bécsi út 132, H-1032 Budapest, Hungary
| | - Tibor Gondos
- Doctoral School of Pathological Sciences, Semmelweis University, Üllői út 26, H-1088 Budapest, Hungary;
| |
Collapse
|
|
4
|
Shan XS, Dai HR, Zhao D, Yang BW, Feng XM, Liu H, Peng K, Ji FH. Dexmedetomidine reduces acute kidney injury after endovascular aortic repair of Stanford type B aortic dissection: A randomized, double-blind, placebo-controlled pilot study. J Clin Anesth 2021; 75:110498. [PMID: 34488061 DOI: 10.1016/j.jclinane.2021.110498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE To determine the effect of dexmedetomidine on acute kidney injury (AKI) following endovascular aortic repair (EVAR) for Stanford type B aortic dissection (TBAD). DESIGN Randomized, double-blind, placebo-controlled, pilot study. SETTING University Hospital. PATIENTS 102 TBAD patients undergoing EVAR procedures were enrolled. Patients with dissection involving aortic arch or renal artery were excluded. INTERVENTIONS Patients were randomly assigned, in a 1:1 ratio, to a dexmedetomidine group (intravenous dexmedetomidine 0.4 μg/kg/h immediately after anesthesia induction and 0.1 μg/kg/h after extubation, which was maintained until 24 h) or a normal saline control group. MEASUREMENTS The primary outcome was the incidence of AKI within the first two days after surgery, based on the Acute Kidney Injury Network (AKIN) criteria. The secondary outcomes included serum cystatin C and estimated glomerular filtration rate on postoperative days 1, 2, and 7, and in-hospital need for renal replacement therapy (RRT). Long-term outcomes included RRT and all-cause mortality. MAIN RESULTS Ninety-eight patients completed the study (dexmedetomidine, n = 48; control, n = 50). AKIN stage 1 AKI occurred in 3/48 (6.3%) patients receiving dexmedetomidine, compared with 11/50 (22%) patients receiving normal saline (odds ratio = 0.24, 95% CI: 0.07 to 0.89, P = 0.041). This difference remained significant after adjusting for baseline covariates (adjusted odds ratio = 0.21, 95% CI: 0.05 to 0.84; P = 0.028). Dexmedetomidine led to a lower serum cystatin C on postoperative day 1 (median [IQR] mg/L: 1.31 [1.02-1.72] vs. 1.58 [1.28-1.96]). There were no between-group differences in other secondary or long-term outcomes. During the follow-up (median = 28.4 months), 1 patient in the dexmedetomidine group and 3 patients in the control group required RRT. CONCLUSIONS Dexmedetomidine reduced the incidence of AKI in TBAD patients after EVAR procedures. The long-term benefits of dexmedetomidine in this patient population warrant further investigation. TRIAL REGISTRATION ChiCTR-IPR-15006372.
Collapse
Affiliation(s)
- Xi-Sheng Shan
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hui-Rong Dai
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China; Department of Anesthesiology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Dan Zhao
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bi-Wen Yang
- Department of Cardiovascular Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiao-Mei Feng
- Department of Anesthesiology, University of Utah Health, Salt Lake City, UT, USA; Transitional Residency Program, Intermountain Medical Center, Murray, UT, USA
| | - Hong Liu
- Department of Anesthesiology and Pain Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Ke Peng
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Fu-Hai Ji
- Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| |
Collapse
|