To the Editor In the study1 comparing effects of HES and 0.9% saline for intravascular volume expansion on postoperative mortality and complications in patients undergoing major abdominal surgery, AKI was defined according to the KDIGO criteria, with a higher incidence of AKI in the HES group compared with the saline group (22% vs 16%). Fluid balances during the first and second postoperative days were significantly different between groups. It was unclear whether the serum creatinine levels used for definition of postoperative AKI had been corrected for fluid balance. Because a positive fluid balance may dilute serum creatinine levels and affect diagnosis of postoperative AKI,2 we are concerned that not adjusting serum creatinine levels for fluid balance may have confounded the incidence of postoperative AKI reported.
Xue F, Liu S, Shao L. Hydroxyethyl Starch vs Saline for Volume Expansion After Abdominal Surgery. JAMA. 2020;324(2):199–200. doi:10.1001/jama.2020.6977
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