Concerns about renal safety of HES 130

hydroxyethyl starch (HES) 130/0.4 in 9,587 patients and a meta-analysis evaluating HES 130/0.42 in 804 patients, HES 130 was shown to increase mortality and the need for renal replacement therapy (RRT) [1]. In the largest included trial of the meta-analysis, the Crystalloid versus Hydroxyethyl Starch Trial (CHEST) with 7,000 ICU patients [2], HES 130/0.4 increased the need for RRT despite a low average daily dose of only 526 ml. e meta-analysis also included RRT data from the CRYSTMAS trial that had not been reported in the original publication of that trial but were later published in a letter to Critical Care [3] and also incorporated in revised US Prescribing Information for HES 130/0.4 [4]. Some authors have nevertheless recently sought to defend the renal safety of HES 130/0.4 [5], in part by citing the absence of signifi cant signs indicating renal dysfunction in a retrospective study by Boussekey and colleagues [6]. In their study of 363 ICU patients, HES 130/0.4 was administered to 168 patients at the low mean cumulative dose of 763 ml over the fi rst 48 hours [6]. No signifi cant diff erence in acute kidney injury was detected using the RIFLE criteria. However, Boussekey and colleagues neglected to report their RRT data. ose data should be reported now, so that they may inform the ongoing debate about the renal safety of HES 130/0.4.