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Modern Starches Are Not Safer than Old Ones

Hartog, Christiane, MD; Reinhart, Konrad, MD

Section Editor(s): Saidman, Lawrence

doi: 10.1213/ane.0b013e3181b366ad
Letters to the Editor: Letters & Announcements

Department of Anesthesiology and Intensive Care Medicine; Friedrich-Schiller-University; Jena, Germany;

The authors report no current conflict of interest. The authors have in the past received unrestricted funding from B. Braun, Melsungen for the conduct of the VISEP study.

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To the Editor:

The review by Boldt1 suggesting that hydroxyethyl starch (HES) 130/ 0.4 is safe requires comments. Evidence has emerged that HES 130/0.4 is as unsafe as HES 200/0.5 in respect to the entire range of starch-related adverse effects, including coagulation in cardiac surgery,2 kidney dysfunction,3 pruritus,4 and tissue storage with risk of organ failure.5 In cardiac surgical patients, HES 130/0.4 impaired clot formation and strength to a similar degree as HES 200/0.5, whereas albumin had no negative effects.2 Chronic application of radio-labeled HES 200/0.5 or 130/0.4 led to reduced overall storage of the latter in rats; however, both HES solutions accumulated in the kidney in similar amounts.6 Renal lesions persist for many years,7 but prospective data on HES 130/0.4 is derived mainly from short perioperative studies in low-risk patients and with low cumulative doses.4

The use of starches is controversial. Despite several decades of widespread HES use, proof of clinical benefit is still lacking, whereas evidence for its negative effects on morbidity and mortality in susceptible patients8–10 is increasing. In view of the many risks, there is no good reason to use HES 130/0.4.

Christiane Hartog, MD

Konrad Reinhart, MD

Department of Anesthesiology and Intensive Care Medicine


Jena, Germany

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1.Boldt J. Modern rapidly degradable hydroxyethyl starches: current concepts. Anesth Analg 2009;108:1574–82
2.Schramko AA, Suojaranta-Ylinen RT, Kuitunen AH, Kukkonen SI, Niemi TT. Rapidly degradable hydroxyethyl starch solutions impair blood coagulation after cardiac surgery: a prospective randomized trial. Anesth Analg 2009;108:30–6
3.Hagne C, Schwarz A, Gaspert A, Giambarba C, Keusch G. HAES in septic shock—sword of Damocles? Schweiz Med Forum 2009;9:304–6. Available at:
4.FDA: Center for Biologics Evaluation and Research. Product approval information—new drug applications. NDA Review Memo (MID-CYCLE), 2007. Last updated April 10, 2008. Available at: Accessed September 10, 2008
5.Schmidt-Hieber M, Loddenkemper C, Schwartz S, Arntz G, Thiel E, Notter M. Hydrops lysosomalis generalisatus—an underestimated side effect of hydroxyethyl starch therapy? Eur J Haematol 2006;77:83–5
6.Leuschner J, Opitz J, Winkler A, Scharpf R, Bepperling F. Tissue storage of 14C-labelled hydroxyethyl starch (HES) 130/0.4 and HES 200/0.5 after repeated intravenous administration to rats. Drugs R D 2003;4:331–8
7.Pillebout E, Nochy D, Hill G, Conti F, Antoine C, Calmus Y, Glotz D. Renal histopathological lesions after orthotopic liver transplantation (OLT). Am J Transplant 2005;5:1120–9
8.Hartog C, Reinhart K. Pro/Con clinical debate: CONTRA: hydroxyethyl starch solutions are unsafe in critically ill patients. Intensive Care Med 2009 Jun 17 [Epub ahead of print] doi: 10.1007/500134-009-1521-5
9.Zarychanski R, Turgeon AF, Fergusson DA, Cook DJ, Hebert P, Bagshaw S, Monsour D, McIntyre LA. Renal outcomes following hydroxyethyl starch resuscitation: a meta-analysis of randomized trials. Intensive Care Med 2008;34:S91A
10.Tseng MY, Hutchinson PJ, Kirkpatrick PJ. Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study. Br J Neurosurg 2008;22:257–68
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