Hydroxyethyl starch after major abdominal surgery not tied to higher risk of kidney injury

France: In major abdominal surgery, hydroxyethyl starch (HES) intravascular volume replacement was not linked with a greater incidence of 30-day acute kidney injury (AKI) as compared to crystalloid intravascular volume replacement, says an article published in Anesthesia & Analgesia.

Warnings concerning the risk of mortality and AKI using HES solutions have been issued in critically unwell patients. However, HES solutions may still have a role in major abdominal surgery. The purpose of this meta-analysis and trial sequential analysis (TSA) was to evaluate the risk of AKI, postoperative intra-abdominal complications, and intraoperative blood transfusion with HES intravascular volume replacement vs crystalloid intravascular volume replacement.

This meta-analysis looked for randomized controlled trials (RCTs) that compared intraoperative HES intravascular volume replacement versus crystalloid intravascular volume replacement in adults following major abdominal surgery. The primary outcome was 30-day AKI, which was defined as a binary outcome using Kidney Disease Improving Global Outcomes (KDIGO) criteria, which included stages 1, 2, and 3 into an AKI category against no AKI category (stage 0). Rates of intraoperative blood transfusion and postoperative intraabdominal problems were secondary outcomes. To produce summary estimates, random-effects models were utilized. For dichotomous outcomes, relative risk (RR) was employed as a summary measure, with matching 95% confidence intervals (CIs) for the primary outcome and 99% CIs after Bonferroni correction for the secondary outcomes.