Instead, the only significant factor was the total mass of HES molecules. The effect was dose-dependent: the greater the molecular mass, the greater the evidence of cell toxicity. The toxic effects started very soon after PTCs were exposed to HEC, and further increased at higher doses.
There is a long history of debate and confusion over potential harmful effects of HES solutions used for resuscitation. Recent studies have linked HES to reduced kidney function in patients with sepsis. Last year, both the US Food and Drug Administration and the European Medicines Agency issued statements that HES solutions should not be used in critically ill patients.
The new study suggests that the molecular mass of HES is the major factor responsible for damage to kidney cells. Other factors have no significant influenceeven with new low-molecular weight HES solutions, cellular-level toxic effects appear just as likely, once the total mass of HES molecules is taken into account.
Although the study was performed in the laboratory on cultured kidney cells, the PTC toxicity caused by HES appears consistent with the risks of kidney damage and death observed in critically ill patients. Dr Wunder and coauthors conclude, "Our data show that HES itself has a negative impact on renal PTC, which should be considered when used clinically."
|Contact: Connie Hughes|
Wolters Kluwer Health