Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity

Monica B. Pagano, Charles Harmon, Laura Cooling, Laura Connelly-Smith, Steven A. Mann, Huy P. Pham, Marisa B. Marques, Annette J. Schlueter, Rosemary Case, Karen Eileen King, Guido Cataife, Yanyun Wu, Edward C C Wong, Jeffrey L. Winters

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures. STUDY DESIGN AND METHODS: We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions. RESULTS: A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms. CONCLUSION: HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.

Original languageEnglish (US)
Pages (from-to)2848-2856
Number of pages9
JournalTransfusion
Volume56
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Leukapheresis
Starch
Kidney
Glomerular Filtration Rate
Therapeutics
Creatinine
Leukostasis
Cell Separation
Serum
Leukocyte Count
Critical Illness
Acute Myeloid Leukemia
Resuscitation
Renal Insufficiency
Leukocytes
Regression Analysis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Hematology

Cite this

Pagano, M. B., Harmon, C., Cooling, L., Connelly-Smith, L., Mann, S. A., Pham, H. P., ... Winters, J. L. (2016). Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity. Transfusion, 56(11), 2848-2856. https://doi.org/10.1111/trf.13795

Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity. / Pagano, Monica B.; Harmon, Charles; Cooling, Laura; Connelly-Smith, Laura; Mann, Steven A.; Pham, Huy P.; Marques, Marisa B.; Schlueter, Annette J.; Case, Rosemary; King, Karen Eileen; Cataife, Guido; Wu, Yanyun; Wong, Edward C C; Winters, Jeffrey L.

In: Transfusion, Vol. 56, No. 11, 01.11.2016, p. 2848-2856.

Research output: Contribution to journalArticle

Pagano, MB, Harmon, C, Cooling, L, Connelly-Smith, L, Mann, SA, Pham, HP, Marques, MB, Schlueter, AJ, Case, R, King, KE, Cataife, G, Wu, Y, Wong, ECC & Winters, JL 2016, 'Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity', Transfusion, vol. 56, no. 11, pp. 2848-2856. https://doi.org/10.1111/trf.13795
Pagano MB, Harmon C, Cooling L, Connelly-Smith L, Mann SA, Pham HP et al. Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity. Transfusion. 2016 Nov 1;56(11):2848-2856. https://doi.org/10.1111/trf.13795
Pagano, Monica B. ; Harmon, Charles ; Cooling, Laura ; Connelly-Smith, Laura ; Mann, Steven A. ; Pham, Huy P. ; Marques, Marisa B. ; Schlueter, Annette J. ; Case, Rosemary ; King, Karen Eileen ; Cataife, Guido ; Wu, Yanyun ; Wong, Edward C C ; Winters, Jeffrey L. / Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity. In: Transfusion. 2016 ; Vol. 56, No. 11. pp. 2848-2856.
@article{e6e5249313df490f9bd339c735b40f49,
title = "Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity",
abstract = "BACKGROUND: Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures. STUDY DESIGN AND METHODS: We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions. RESULTS: A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms. CONCLUSION: HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.",
author = "Pagano, {Monica B.} and Charles Harmon and Laura Cooling and Laura Connelly-Smith and Mann, {Steven A.} and Pham, {Huy P.} and Marques, {Marisa B.} and Schlueter, {Annette J.} and Rosemary Case and King, {Karen Eileen} and Guido Cataife and Yanyun Wu and Wong, {Edward C C} and Winters, {Jeffrey L.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1111/trf.13795",
language = "English (US)",
volume = "56",
pages = "2848--2856",
journal = "Transfusion",
issn = "0041-1132",
publisher = "Wiley-Blackwell",
number = "11",

}

TY - JOUR

T1 - Use of hydroxyethyl starch in leukocytapheresis procedures does not increase renal toxicity

AU - Pagano, Monica B.

AU - Harmon, Charles

AU - Cooling, Laura

AU - Connelly-Smith, Laura

AU - Mann, Steven A.

AU - Pham, Huy P.

AU - Marques, Marisa B.

AU - Schlueter, Annette J.

AU - Case, Rosemary

AU - King, Karen Eileen

AU - Cataife, Guido

AU - Wu, Yanyun

AU - Wong, Edward C C

AU - Winters, Jeffrey L.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - BACKGROUND: Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures. STUDY DESIGN AND METHODS: We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions. RESULTS: A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms. CONCLUSION: HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.

AB - BACKGROUND: Hydroxyethyl starch (HES) is reportedly associated with an increased risk of renal failure and death when used for fluid resuscitation in critically ill patients. HES can be used during therapeutic leukocytapheresis (TL) procedures to enhance cell separation. The purpose of this study was to evaluate the occurrence of adverse events associated with HES during TL procedures. STUDY DESIGN AND METHODS: We performed a retrospective review of patients who underwent TL with and without HES in the period 2009 to 2013 at six academic medical institutions. RESULTS: A difference-in-difference regression analysis was used to estimate the mean change before and after TL in selected outcomes in the HES group relative to the average change in the non-HES group. Selected outcomes included serum creatinine, estimated glomerular filtration rate (eGFR), and white blood cell (WBC) count. A total of 195 patients who underwent 278 TL procedures were studied. We found no significant differences in serum creatinine levels and eGFR on Days 1 and 7 after TL procedure between patients who received and those who did not receive HES. The rate of adverse events and overall and early mortality were similar in both groups. Patients with acute myeloid leukemia who received HES had greater WBC reduction when HES was used. Additionally, patients who received HES had improvement in pulmonary leukostasis symptoms. CONCLUSION: HES, used at low doses during TL procedures, was not associated with adverse events previously ascribed to its use as a volume expander.

UR - http://www.scopus.com/inward/record.url?scp=84992608905&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992608905&partnerID=8YFLogxK

U2 - 10.1111/trf.13795

DO - 10.1111/trf.13795

M3 - Article

C2 - 27600855

AN - SCOPUS:84992608905

VL - 56

SP - 2848

EP - 2856

JO - Transfusion

JF - Transfusion

SN - 0041-1132

IS - 11

ER -