title: Update on the comparative safety of colloids: a systematic review of clinical studies.
abstract: OBJECTIVE
  To provide an updated systematic review on the comparative safety of colloids based on recent clinical studies.
  
  
  BACKGROUND
  Recent investigations, including large-scale randomized trials and meta-analyses, have sought to determine the effects of colloids on mortality and morbidity. Hypothesized differences in safety profile between hydroxyethyl starch (HES) solutions have also been evaluated in randomized trials.
  
  
  METHODS
  Clinical studies reported since 2002 with safety data for acutely ill patients receiving HES, gelatin, dextran, or albumin were sought by computer searches and other methods. Safety endpoints included mortality, morbidity, bleeding and impaired coagulation, and acute kidney injury (AKI). Data extracted from the included study reports were qualitatively summarized.
  
  
  RESULTS
  Sixty-nine clinical studies were included. Of those, 42 were randomized controlled trials (RCTs) with 10,382 total patients. New safety data, since 2002, predominantly concerned albumin or HES. A large RCT of intensive care unit patients showed that albumin does not adversely affect survival. Acute kidney injury and a dose-dependent increase in mortality were observed in a large RCT of patients with severe sepsis or septic shock receiving HES. Impaired coagulation and clinical bleeding were frequently reported after HES infusion, especially in cardiac surgery. In head-to-head randomized comparisons of different HES solutions, observed effects on coagulation and renal function were similar. Gelatin showed less impairment of coagulation than HES. Very few safety data related to dextran were identified.
  
  
  CONCLUSIONS
  Albumin displayed a more favorable safety profile than HES. Available evidence does not support the existence of consistent safety differences between HES solutions.
authors.affiliation: Department of Intensive Care, Vrije Universiteit Medical Center, Amsterdam, The Netherlands.
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
authors.forename: Roberta J
authors.initials: RJ
authors.lastname: Navickis
authors.forename: Mahlon M
authors.initials: MM
authors.lastname: Wilkes
mesh_terms: D003102:Colloids; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation / Q000379:methods*; D012709:Serum Albumin / Q000008:administration & dosage* / Q000009:adverse effects; D015996:Survival Rate
chemical_list: D003102:Colloids; D003911:Dextrans; D006895:Hydroxyethyl Starch Derivatives; D012709:Serum Albumin; D005780:Gelatin