Reversal of Acute Renal Failure Using Hemodilution with Hydroxyethyl Starch

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Abstract
Acute renal failure (ARF) was induced in 2 groups of unilaterally nephrectomized dogs by occluding the renal artery, vein, and ureter of the remaining kidney for 2 hours. The control group (group I), had no therapy; in the experimental group (group II), isovolemic hemodilution was carried out using 6% hydroxy ethyl starch (HES) as diluent. The hematocrit in the experimental animals was lowered from 41.62 .+-. 3.6% to 23.75 .+-. 5.2% after renal occlusion. The mean arterial pressure and the mean pulmonary arterial pressure were unchanged in either group. Cardiac output increased following hemodilution from 1.66 .+-. 0.35 to 2.70 .+-. 0.50 l/min while it remained unchanged in group I. Control animal developed ARF characterized by progressive rise in serum creatinine concentration and death. Only 1/7 group I animals was alive on day 7 compared to 7/7 of group II (P < 0.01). ARF that developed initially in group II began to resolve after day 4. There was a progressive and significant fall in serum creatinine concentration from 6.48 .+-. 0.67 mg/dl on day 4 to 4.08 .+-. 0.83 mg/dl on day 7 (P < 0.001). Immediate isovolemic hemodilution with HES can reverse ARF induced by ischemia.