Hydroxyethyl starch impairs renal water reabsorption in patients with cardiac shock

Hydroxyethyl starch (HES) has been shown to be correlated with increased risk of renal dysfunction. While almost all articles focus on the side effect of HES on glomerular filtration function, it is barely known to us about the effect of HES on renal water reabsorption. The objective of this study is to assess the effect of HES on renal water reabsorption in patients with cardiac shock. In a retrospective cohort-study, 162 patients admitted to the department of cardiology and diagnosed as cardiac shock were randomized into four groups, depending on different treatments of NaCl (NaCl group), HES (HES group), HES and dopamine (HES + DOP group), HES and norepinephrine (HES + NE group). Data collected included age, sex, blood pressure, heart rate, left ventricular ejection fraction, serum creatinine, blood urea nitrogen, urine specific gravity, urine volume, oxygen saturation serum, drug dosage, and so on. Indices related to renal function were recorded before and after the anti-shock treatments. The comparison was performed among four groups at day 0 or at day 3, and indices of the same group were compared between day 0 and day 3. We found that HES and norepinephrine reduced the urine specific gravity in HES group (day 0 vs day 3, 1.019± 0.006 vs 1.012 ± 0.005, p < 0.001) and in HES + NE group (day 0 vs day 3, 1.019 ± 0.006 vs 1.011 ± 0.004, p < 0.001). Dopamine increased the urine volume of HES-treated patients at day 3 (p < 0.001), and in the meantime dopamine preserved urine specific gravity during anti-shock treatment at day 3 (p = 0.13). In conclusion, hydroxyethyl starch caused injured function of renal water reabsorption, and dopamine protected renal water reabsorption in HES-treated patients via increased renal blood.