Are renal adverse effects of hydroxyethyl starches merely a consequence of their incorrect use?

Hartog, Christiane S.; Brunkhorst, Frank M.; Engel, Christoph; Meier‐Hellmann, Andreas; Ragaller, M.; Welte, Tobias; Kuhnt, Evelyn; Reinhart, Konrad

doi:10.1007/s00508-011-1532-4

Cited by 12 publications

(7 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This was previously found for other HES formulations [8,9,12] and suspected for 6% tetrastarch. [54] The point estimates are concordant and the pooled CI is narrower than already reported in trials, [3,25] improving precision. Sensitivity analysis did not alter this finding suggesting it is robust.…”

Section: Discussionmentioning

confidence: 66%

“…The total 6% tetrastarch dose exposures were below 50 ml/kg, and 3000 ml or less (Table 2, online supplement), thus incorrect use was not a major factor. [54] Some of the renal toxicity has been attributed to 43% tissue uptake [53] and perhaps the effects of direct urinary ultrafiltration of less than 60 kDa molecules. [51] Overall, one patient with severe sepsis required RRT for every 16 patients treated with 6% tetrastarch instead of (crystalloid) control fluid.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

View full text Add to dashboard Cite

PurposeTo assess the impact of 6% tetrastarch (hydroxyethyl starch (HES) 130/0.4 and 130/0.42) in severe sepsis patients. The primary outcome measure was 90-day mortality. MethodsA structured literature search to identify prospective randomized controlled trials (RCT) in adult patients with severe sepsis receiving 6% tetrastarch (potato or waxy maize origin), as part of fluid resuscitation in comparison to other non-HES fluids after randomisation, in the critical care setting was undertaken. A systematic review and meta-analysis was performed. ResultsSix RCTs were included (n = 3033): three from 2012 (n = 2913) had a low risk of bias. Median tetrastarch exposure was 37.4 ml/kg (range 30 to 43). Ninety-day mortality was associated with tetrastarch exposure (relative risk (RR) 1.13; 95% confidence interval (CI) 1.02 to 1.25; p = 0.02) compared to crystalloid. The number needed to harm (NNH) was 28.8 (95% CI 14.6 to 942.5). Publication bias and statistical heterogeneity (I 2 = 0%) were not present. Tetrastarch exposure was also associated with renal replacement therapy (p = 0.01; NNH 15.7) and allogeneic transfusion support (p = 0.001; NNH 9.9). No difference between groups was observed for 28-day mortality, comparison with colloid as control, and for waxy maize derived tetrastarch, but power was lacking. Overall mortality was associated with tetrastarch exposure (RR 1.13; 95% CI 1.02 to 1.25; p = 0.02). ConclusionsIn our analysis, 6% tetrastarch as part of initial fluid resuscitation for severe sepsis was associated with harm, and as alternatives exist, in our view should be avoided.

show abstract

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

View full text Add to dashboard Cite

show abstract

“…A historical animal study demonstrated a MAP of 50 to 60 mmHg to be the lower limit of autoregulation of renal blood flow. Numerous clinical studies have demonstrated deleterious renal effects of commonly administered resuscitation fluids, namely, synthetic colloids [18][19][20][21][22][23] and normal saline (via development of hyperchloremia). 16 Renovascular reactivity has recently been measured by near-infrared spectroscopy by Rhee et al 17 This study demonstrated that in preterm piglets, renal blood flow decreased to 75, 50, and 25% of baseline, respectively, when MAP decreased to 60, 45, and 40 mmHg.…”

Section: Perioperative Medicinementioning

confidence: 99%

Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

et al. 2015

View full text Add to dashboard Cite

show abstract

“…As per general recommendations, colloids are not indicated once these goals have been achieved. [ 28 29 30 31 ]…”

Section: Critical Analysis Of Three Large Trialsmentioning

confidence: 99%

Hydroxyeyhyl starch: Controversies revisited

Datta

Nair

Pandey

et al. 2014

J Anaesthesiol Clin Pharmacol

View full text Add to dashboard Cite

Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.

show abstract

Are renal adverse effects of hydroxyethyl starches merely a consequence of their incorrect use?

Abstract: There is no evidence for the assumption that HES-associated renal impairment may be avoided by accompanying measures. Because HES use does not improve clinical outcome, the question arises whether it should be used at all in patients at risk.

Cited by 12 publications

References 56 publications

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

Hydroxyeyhyl starch: Controversies revisited

Contact Info

Product

Resources

About