Renal impact of fluid management with colloids: a comparative review

Abstract

Background and objectives: Colloids such as hydroxyethyl starch (HES), gelatin, dextran and albumin are useful for maintaining renal perfusion and function. The comparative renal effects of colloids have not been previously reviewed.

Methods: Computer searches of the MEDLINE and EMBASE bibliographic databases and the Cochrane Library were conducted using the search terms: colloids; hetastarch; gelatin; dextrans; serum albumin; kidney failure; cardiac surgical procedures; and kidney transplantation. Relevant studies were also sought through hand searching and examination of reference lists. Results of identified studies were qualitatively summarized with account taken for potential confounding factors.

Results: The three artificial colloids HES, gelatin and dextran all exhibited troublesome renal side-effects. Randomized trials have demonstrated adverse renal effects of HES in sepsis and surgery. Undesirable renal effects are common to all available HES solutions regardless of molecular weight, substitution or C2/C6 ratio. While some of its effects may be less severe than those of HES, gelatin also can adversely affect the kidney. A negative renal impact of dextran is well-established, although this colloid is now less extensively used than formerly. As the normal endogenous colloid, albumin exhibits a wide margin of renal safety, although albumin overdose needs to be avoided. Albumin also appears to exert protective effects on the kidney such as inhibition of apoptosis and scavenging of reactive oxygen species.

Conclusions: Colloids display important differences in their actions on the kidney. These contrasting renal effects should be considered in making fluid management decisions.