This meta-analysis assessed the association of different hydroxyethyl starch solutions with mortality and acute kidney injury in an heterogenous population of critically ill patients who required volume resuscitation. When excluding the 7 studies published by Boldt before 1999, the authors observed that the use of hydroxyethyl starch was associated with an increased risk of mortality and acute kidney injury in the studied population.

Methodological limiations of this well-conducted meta-analysis are adequately acknowledged by the authors who grade the strength of evidence of their analysis as moderate. Although these results have to be taken ito consideration, they cannot be directly extrapolated to other populations, e.g. surgicalpatients, who clearly present different characteristics.

Well-designed studies evaluating the efficacy and the safety of hydroxyethyl starch administration in surgical patients are urgently required.

– Philippe Van der Linden