Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis

Abstract

We did not identify any differences in the incidence of death or AKI in surgical patients receiving 6% HES. Included studies were small with low event rates and low risk of heterogeneity. Narrow CIs suggest that these findings are valid. Given the absence of demonstrable benefit, we are unable to recommend the use of 6% HES solution in surgical patients.

State of the art in fluid and volume therapy

“…However, the majority of the included studies had insufficiently long observation periods and no real control group. A further study without industry funding came to the same conclusion with the same shortcomings of the included studies [64]. To prove the safety of HES in the OR -analogous to intensive care medicine -correspondingly conceived, randomized, controlled, and blinded trials are also required.…”

Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions

“…This a priori should be faster with colloids, since, as demonstrated in healthy patients and animal models, the proportion of liquid required to achieve a goal of hemodynamic stabilization is 1:4 42 ; however, this cannot be confirmed by the data obtained in this meta-analysis nor can be demonstrated with recent studies specifically designed to determine it. 33 The association of RI with the use of colloids in the surgical field could not be demonstrated, 20,43 and in particular in GDFT it can be demonstrated, since no RCT analyzed this as a primary outcome; thus, it is not possible to draw conclusions with regard to colloids association with renal failure in surgical patients who underwent GDFT.…”

“…19 These conclusions were based on studies of patients with sepsis, not in the context of intraoperative hemodynamic stabilization from bleeding or relative hypovolemia, and the possibility of extrapolating the findings is debatable. Recently Gillies et al, 20 after performing a systematic review and meta-analysis in which colloids were compared with different kinds of liquids, concluded that the use of HES did not increase mortality, hospital stay, RI or the need for extrarenal clearance 20 ; however, in this meta-analysis colloids are not compared with crystalloids in studies which used a GDFT algorithm and included only three randomized controlled trials (RCTs), in which colloids were compared to crystalloids in noncardiac surgery. 21---23 The objective of this systematic review and meta-analysis is to determine whether the use of the latest generation of colloids derived from corn (HE 6%: 130/0.4) for hemodynamic optimization in GDFT reduces postoperative complications and mortality.…”

Anesthesia for Colorectal Surgery

“…104 Recent data have suggested that the use of hydroxyethyl starch (HES) solutions can increase the risk of death and acute kidney injury in critically ill patients, 107,108 but these results have not been confirmed in the perioperative setting. 109 Moreover, the use of large volumes of HES 130/0.4 (2605 AE 512 mL) during major urologic procedures has been shown to impair hemostasis and increase blood loss in comparison with crystalloid solutions. 110 Nevertheless, intraoperative crystalloids-based fluid regimens increase the risk of fluid overload.…”