title: Incidence of postoperative death and acute kidney injury associated with i.v. 6% hydroxyethyl starch use: systematic review and meta-analysis.
abstract: BACKGROUND
  Trials suggest that the use of i.v. hydroxyethyl starch (HES) solutions is associ-ated with increased risk of death and acute kidney injury (AKI) in critically ill patients. It is uncertain whether similar adverse effects occur in surgical patients.
  
  
  METHODS
  Systematic review and meta-analysis of trials in which patients were randomly allocated to 6% HES solutions or alternative i.v. fluids in patients undergoing surgery. Ovid Medline, Embase, Cinhal, and Cochrane Database of Systematic Reviews were searched for trials comparing 6% HES with clinically relevant non-starch comparator. The primary end-point was hospital mortality. Secondary endpoints were requirement for renal replacement therapy (RRT) and author-defined AKI. Pre-defined subgroups were cardiac and non-cardiac surgery.
  
  
  RESULTS
  Four hundred and fifty-six papers were identified; of which 19 met the inclusion criteria. In total, 1567 patients were included in the analysis. Dichotomous outcomes were expressed as a difference of proportions [risk difference (RD)]. There was no difference in hospital mortality [RD 0.00, 95% confidence interval (CI) -0.02, 0.02], requirement for RRT (RD -0.01, 95% CI -0.04, 0.02), or AKI (RD 0.02, 95% CI -0.02 to 0.06) between compared arms overall or in predefined subgroups.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Critical Care, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Gillies
authors.forename: M
authors.initials: M
authors.lastname: Habicher
authors.forename: S
authors.initials: S
authors.lastname: Jhanji
authors.forename: M
authors.initials: M
authors.lastname: Sander
authors.forename: M
authors.initials: M
authors.lastname: Mythen
authors.forename: M
authors.initials: M
authors.lastname: Hamilton
authors.forename: R M
authors.initials: RM
authors.lastname: Pearse
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects*; D015994:Incidence; D007262:Infusions, Intravenous; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D016032:Randomized Controlled Trials as Topic
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: hetastarch; meta-analysis; surgery