This review included 42 randomized controlled trials (for a total of 11,399 patients): 19 studies from a previous review and 23 new studies, in which hydroxyethyl starch (HES) solutions were compared to an alternative fluid therapy for the prevention of effective intravascular volume depletion. Primary outcomes were renal replacement therapy and acute kidney injury (AKI) as defined by the RIFLE criteria. Overall, there was a significant increase in the need for renal replacement in the HES group (RR 1.31, 95 % CI, 1.16 to 1.49) and AKI based on RIFLE-Failure (RR 1.14, 95% CI 1.01 to 1.30). Interestingly, no differences for the renal replacement and RIFLE-Failure were observed related to the type of patients (septic or not), molecular weight and degree of substition or doses of HES. This review is an additional argument to limit the use of HES due to their potential deleterious effects on renal function.
– Michael Piagnerelli