RENAL OUTCOMES FOLLOWING HYDROXYETHYL STARCH RESUSCITATION: A META-ANALYSIS OF RANDOMISED TRIALS

Objectives: To evaluate the impact of HES solutions on adverse renal outcomes and mortality in critically ill patients requiring acute volume resuscitation. Design: Systematic review and meta-analysis of randomized controlled trials. Data Sources: We searched electronic databases from 1950 to 2007 (MEDLINE, EMBASE, the Cochrane Central Registry of Controlled Trials, and the SCOPUS database). Conference proceedings and grey literature sources were also searched from 2002-2007. Review Methods: We included all randomised controlled trials of patients requiring acute volume resuscitation who received HES compared to an alternative resuscitation fluid. No restrictions were considered regarding language or publication type. Data were independently extracted in duplicate. Results:Of 2381 citations reviewed, we included 22 trials (n=1866) in the analysis. Patients receiving HES were more likely to receive renal replacement therapy [odds ratio [OR] 1.91 (95% confidence interval [CI] 1.22-2.99, I^210.5%)]. This was also true for patients with severe sepsis or septic shock [OR 1.82 (95% CI 1.27-2.62, I^20%)]. In high quality trials, multicentre trials, and in reports indicating adequate allocation concealment, there was a trend toward increased risk of death associated with HES. Other adverse events were not systematically evaluated and were poorly reported. Limitations: Considerable clinical and methodologic heterogeneity exists among these trials. Conclusions: The use of HES for volume resuscitation in critically ill patients is associated with increased use of renal replacement therapy and may result in increased mortality. We caution against the routine use of HES for volume resuscitation in critically ill patients.