Accumulation of hydroxyethyl starch in human and animal tissues: a systematic review
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Christian J. Wiedermann Michael Joannidis
SYSTEMATIC REVI EW
Accumulation of hydroxyethyl starch in human and animal tissues: a systematic review
Abstract Purpose: To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage. Methods: MEDLINE (PubMed) was searched and abstracts were screened using defined criteria Electronic supplementary material The online version of this article to identify articles containing original (doi:10.1007/s00134-013-3156-9) contains data on HES tissue accumulation. supplementary material, which is available Results: Forty-eight studies were to authorized users. included: 37 human studies with a total of 635 patients and 11 animal studies. The most frequent indication for fluid infusion was surgery accounting for 282 patients (45.9 %). HES localization in skin was shown by 17 studies, in kidney by 12, in liver by 8, and in bone marrow by 5. C. J. Wiedermann ()) Additional sites of HES deposition Department of Internal Medicine, Central Hospital of Bolzano, Lorenz-Bo¨hler-Street were lymph nodes, spleen, lung, pancreas, intestine, muscle, tropho5, 39100 Bolzano, Italy e-mail: [email protected] blast, and placental stroma. Among Tel.: ?39-471-908190 major organs the highest measured Fax: ?39-471-908303 tissue concentration of HES was in the kidney. HES uptake into intraM. Joannidis Division of Emergency and Intensive Care cellular vacuoles was observed by Medicine, Department of Internal Medicine, 30 min after infusion. Storage was Medical University of Innsbruck, Innsbruck, cumulative, increasing in proportion Received: 24 July 2013 Accepted: 5 November 2013 Published online: 21 November 2013 Ó Springer-Verlag Berlin Heidelberg and ESICM 2013
to dose, although in 15 % of patients storage and associated symptoms were demonstrated at the lowest cumulative doses (0.4 g kg-1). Some HES deposits were extremely longlasting, persisting for 8 years or more in skin and 10 years in kidney. Pruritus associated with HES storage was described in 17 studies and renal dysfunction in ten studies. In one included randomized trial, HES infusion produced osmotic nephrosis-like lesions indicative of HES storage (p = 0.01) and also increased the need for renal replacement therapy (odds ratio, 9.50; 95 % confidence interval, 1.09–82.7; p = 0.02). The tissue distribution of HES was generally similar in animals and humans. Conclusions: Tissue storage of HES is widespread, rapid, cumulative, frequently long-lasting, and potentially harmful. Keywords Hydroxyethyl starch Hetastarch Storage Accumulation Uptake Deposit
Austria
Introduction The artificial colloid hydroxyethyl starch (HES) is administered intravenously to treat or prevent hypovolemia. While circulating in the plasma, HES exerts colloid osmotic pressure that causes water to remain in or to be drawn into the plasma to increase blood volume. Since its introduction in the 1970s, several HES products, differing
in physicochemical properties such as molecular weight and degree and pattern of hy
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