title: Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy.
abstract: OBJECTIVE
  To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.
  
  
  RESULTS
  Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I (2) = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I (2) = 0 %).
  
  
  CONCLUSIONS
  The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.
authors: The George Institute for Global Health, Sydney, Australia. dgattas@med.usyd.edu.au
authors: David J
authors: DJ
authors: Gattas
authors: Arina
authors: A
authors: Dan
authors: John
authors: J
authors: Myburgh
authors: Laurent
authors: L
authors: Billot
authors: Serigne
authors: S
authors: Lo
authors: Simon
authors: S
authors: Finfer
mesh_terms: D000328:Adult; D016638:Critical Illness; D016206:Databases, Bibliographic; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy / Q000379:methods* / Q000401:mortality; D012151:Resuscitation / Q000379:methods; D012306:Risk
chemical_list: D006895:Hydroxyethyl Starch Derivatives