Title
Hydroxyl Ethyl Starch (HES) Preserves Intrarenal Microcirculatory Perfusion Shown by Contrast-Enhanced Ultrasound (Ceus), and Renal Function in a Severe Hemodilution Model in Pigs
Author
Ergin, Bülent (Erasmus MC)
van Rooij, Tom (Erasmus MC)
Lima, Alexandre (Erasmus MC)
Ince, Yasin (Erasmus MC)
Specht, Patricia A.C. (Erasmus MC)
Mik, E.G. (Erasmus MC)
Kooiman, Klazina (Erasmus MC)
de Jong, N. (TU Delft ImPhys/Medical Imaging; Erasmus MC)
Ince, Can (Erasmus MC)
Date
2022
Abstract
Acute normovolemic hemodilution (ANH) is associated with low oxygen carrying capacity of blood and purposed to cause renal injury in perioperative setting. It is best accomplished in a perioperative setting by a colloid such as hydroxyl ethyl starch (HES) due its capacity to fill the vascular compartment and maintain colloidal pressure. However, alterations of intra renal microvascular perfusion, flow and its effects on renal function and damage during ANH has not been sufficiently clarified. Based on the extensive use of HES in the perioperative setting we tested the hypothesis that the use of HES during ANH is able to perfuse the kidney microcirculation adequately without causing renal dysfunction and injury in pigs. Hemodilution (n = 8) was performed by stepwise replacing blood with HES to hematocrit (Hct) levels of 20% (T1), 15% (T2), and 10% (T3). Seven control animals were investigated. Systemic and renal hemodynamics were monitored. Renal microcirculatory perfusion was visualized and quantified using contrast-enhanced ultrasound (CEUS) and laser speckle imaging (LSI). In addition, sublingual microcirculation was measured by handheld vital microscopy (HVM). Intrarenal mean transit time of ultrasound contrast agent (IRMTT-CEUS) was reduced in the renal cortex at Hct 10% in comparison to control at T3 (1.4 ± 0.6 vs. 2.2 ± 0.7 seconds, respectively, P < 0.05). Although renal function was preserved, the serum neutrophil gelatinase-associated lipocalin (NGAL) levels was higher at Hct 10% (0.033 ± 0.004 pg/μg protein) in comparison to control at T3 (0.021 ± 0.002 pg/μg protein. A mild correlation between CO and IRMTT (renal RBC velocity) (r -0.53; P = 0.001) and CO and NGAL levels (r 0.66; P = 0.001) was also found. Our results show that HES induced ANH is associated with a preserved intra renal blood volume, perfusion, and function in the clinical range of Hct (<15%). However, at severely low Hct (10%) ANH was associated with renal injury as indicated by increased NGAL levels. Changes in renal microcirculatory flow (CEUS and LSI) followed those seen in the sublingual microcirculation measured with HVM.
Subject
Acute normovolemic hemodilution
contrast-enhanced ultrasound
hydroxyethyl starch
renal microcirculation
sublingual microcirculation
To reference this document use:
http://resolver.tudelft.nl/uuid:dca5afec-3b08-46fa-ab09-d6081cebab7a
DOI
https://doi.org/10.1097/SHK.0000000000001862
Embargo date
2023-07-01
Source
Shock (Augusta, Ga.), 57 (3), 457-466
Bibliographical note
Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.
Part of collection
Institutional Repository
Document type
journal article
Rights
© 2022 Bülent Ergin, Tom van Rooij, Alexandre Lima, Yasin Ince, Patricia A.C. Specht, E.G. Mik, Klazina Kooiman, N. de Jong, Can Ince