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Related Experiment Videos

Hydroxyethyl Starch and Perioperative Complications: a Systematic Review and Meta-analysis.

Daniel I Sessler1,2, Lorenzo Pradelli3, Massimiliano Povero3

  • 1Center for Outcomes Research and Department of Anesthesiology, UTHealth, Houston, Texas.

Anesthesiology
|May 20, 2026
PubMed
Summary

Current hydroxyethyl starch (HES) solutions, specifically HES 130/0.4 or HES 130/0.42, do not increase the risk of acute kidney injury in surgical patients. This meta-analysis found no significant renal injury or adverse events associated with HES use.

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Area of Science:

  • Nephrology
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Regulatory agencies issued warnings on hydroxyethyl starch (HES) due to renal injury concerns in critically ill and septic patients.
  • Black box warnings were expanded to surgical and trauma patients, leading to product withdrawals in some regions.
  • A previous meta-analysis on perioperative HES use prompted this new study focusing on renal injury in surgical patients.

Purpose of the Study:

  • To conduct a new meta-analysis evaluating the renal safety of hydroxyethyl starch (HES) 130/0.4 and HES 130/0.42 in surgical patients.
  • To assess the risk of acute kidney injury (AKI) and changes in creatinine concentration following HES administration.
  • To complement existing research and address regulatory concerns regarding HES use.

Main Methods:

  • Searched 4 publication databases in 6 languages using predefined criteria for relevant trials.
  • Included 114 trials (2009-2026) with 13,951 patients, focusing on HES 130/0.4 or HES 130/0.42 use.
  • Utilized standard meta-analytic techniques with random-effect models, evaluating trial quality and publication bias.

Main Results:

  • HES 130/0.4 or HES 130/0.42 did not significantly increase the risk of acute kidney injury (RR 1.02 [0.91, 1.16]).
  • No significant worsening of preoperative-to-postoperative creatinine concentration was observed (-0.62 [-3.82, 2.57] µmol/L).
  • Trial sequential analysis confirmed non-inferiority for creatinine change, and HES did not meaningfully worsen other adverse events or mortality.

Conclusions:

  • Current hydroxyethyl starch solutions (HES 130/0.4 and HES 130/0.42) do not provoke renal injury in surgical patients.
  • The findings support the safe use of these HES formulations within the studied perioperative context.
  • Further research may refine understanding, but current evidence suggests renal safety for HES in surgery.