ICU fluid replacement increases renal failure

The NHMRC-funded study, conducted at 32 hospitals in Australia and New Zealand, may lead to more careful selection of patients for volume expansion with HES as it found a 21% increased risk of renal replacement therapy compared to saline.

The researchers set out to see if survival was better with HES but the trial failed to find any significant difference in mortality between ICU patients receiving HES (18%) or those receiving saline (17%).

However it did reveal an increased risk of haemodialysis and other adverse events, including increased use of blood products and of pruritus and rash.

“The study does not provide evidence that resuscitation with starch compared to saline in intensive care provides any clinical benefit to the patient,” said lead investigator Professor John Myburgh, director of critical care and trauma at the George Institute, Sydney.

In the study known as CHEST (Crystalloid vs Hydroxyethyl Starch Trial) some