Adverse effects of volume therapy with hes solutions on kidney function: meta-analysis of prospective, randomized controlled trials
| Author | Affiliation |
|---|---|
De Waele, Jan | Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium |
Decruyenaere, Johan | Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium |
Hoste, Eric A. | Ghent University Hospital, Department of Intensive Care Medicine, Ghent, Belgium |
| Date |
|---|
2009-10-11 |
Impact Factor: 5.168 (2009) *
Introduction. Hydroxyethyl starch (HES) solutions are synthetic colloids with pharmacological properties similar to natural colloids. HES is widely used for intravascular volume replacement. Administration of HES has been suggested to be associated with an increased risk of acute kidney injury (AKI), especially for the older generation of HES solutions with a molecular weight =200kD (HES 200) compared to the new generation HES 130.Objectives. The aim of this study was to investigate the effect of HES administration on kidney function compared with other colloids or crystalloids.Methods. Systematic review and meta-analysis of the effects of HES administration on kidney function. Inclusion criteria for the study were prospective randomized trials comparing HES to control with reporting on variables of kidney function. Results. 18 prospective, randomized studies, including 1871 patients were included in the meta-analysis. Two studies (n=662 patients) reported on AKI defined by a doubling of serum creatinine or treatment with renal replacement therapy, 8 studies (n=694 patients) reported on changes of serum creatinine, 2 studies (n=82) reported on changes in serum urea, and sixteen studies (n= 1005) reported on urine output. Except for AKI, kidney function variables were only reported within a 24 h time period after administration of HES or control solutions. There was considerable statistical and clinical heterogeneity between studies. All 3 kidney outcome variables remained unchanged after administration of HES (creatinine: mean difference = -2,68 µmol/L, 95% confidence interval [CI]= -8,33, 2.98; serum urea: mean difference = -0.16 µmol/L, 95% CI= -0.85, 0.53; and urine output: mean difference = 49.29 mL/24 h, 95% CI= -99.29, 197.87). The effects of HES on these kidney outcome variables was comparable in patients who were administered HES 130 versus HES 200 solutions. Risk for AKI was only asse