PRO: hydroxyethylstarch can be safely used in the intensive care patient--the renal debate.

Abstract

Correcting hypovolemia is fundamental when treating the critically ill. Different hydroxyethylstarch (HES) preparations with different physicochemical characteristics (mean molecular weight (Mw), molar substitution (MS), C2/C6 ratio, balanced/unbalanced) are available. The possible detrimental effect of HES on kidney function has become a major objection to using HES. This review focuses on the effect of HES on kidney function. First and second-generation HES with high Mw (>200 kD) and high MS (>0.5) have been shown to impair kidney function in some studies of septic patients, especially when using hyperoncotic HES. More rapidly degradable HES preparations (Mw 130 kD; MS < 0.5) did not cause deterioration of kidney function in a variety of clinical conditions. Even when kidney function was impaired (serum creatinine >1.5 mg/dL) this HES preparation was without negative effect. Dissolving HES in a balanced solution instead of saline may further improve the safety of HES with regard to kidney function. Dose limitations of the specific HES preparation should be carefully considered. Hyperoncotic HES should not be used in patients who are at risk of developing kidney dysfunction. In patients without preexisting kidney dysfunction there seems to be no negative effects of modern HES preparations. In septic patients with reduced kidney function (serum creatinine >2.5 mg/dL) HES should be used cautiously, because studies of these patients are not available. Dissolving HES in a balanced solution further improves the safety of HES with regard to kidney function. At present, there seems to be no good reason to generally ban use of HES in our patients.