Hydroxyethyl starch (HES) versus other fluid therapies: effects on kidney function.

Area of Science:

• Nephrology
• Critical Care Medicine
• Pharmacology

Background:

• Hydroxyethyl starches (HES) are widely used synthetic colloids for fluid resuscitation.
• Concerns exist regarding the potential adverse effects of HES on renal function.

Purpose of the Study:

• To evaluate the impact of HES on kidney function compared to alternative fluid therapies.
• To assess renal outcomes in various patient populations receiving HES.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
• Searched multiple databases including Cochrane, MEDLINE, and EMBASE.
• Primary outcomes included renal replacement therapy (RRT), kidney failure, and acute kidney injury (AKI) using RIFLE criteria.

Main Results:

• HES use was associated with an increased risk of author-defined kidney failure (RR 1.50) and a trend towards increased RRT (RR 1.38).
• Subgroup analysis indicated a higher risk in septic patients compared to non-septic patients.
• Methodological quality was generally good, but unblinding may have introduced bias.

Conclusions:

• The potential for increased AKI risk with HES necessitates careful risk-benefit assessment, particularly in septic patients.
• Large, well-designed studies are required to ascertain the renal safety of HES in non-septic populations.
• Future research should utilize RIFLE criteria for consistent kidney function evaluation.