NEW YORK (Reuters Health) – The use of artificial colloids for intravascular volume expansion is associated with greater risk of acute kidney injury and impaired coagulation than is the use of albumin, according to a review of recent clinical evidence.

“The effectiveness of colloids for maintaining hemodynamic stability is well-documented,” Dr. Mahlon M. Wilkes with Hygeia Associates in Grass Valley, California, and colleagues in Amsterdam write in their report in the Annals of Surgery online January 6.

However, there is widespread interest in colloid safety, they note. “The purpose of the present systematic review is to provide an update on the comparative safety of colloids based upon the extensive clinical data accumulated since 2002.”

The authors identified 69 studies on the topic, of which 42 were randomized clinical trial involving a total of 10,382 patients. Their analysis focuses largely on comparing hydroxyethyl starch (HES) solutions with other colloids.

In terms of bleeding risk, for example, the data indicate that HES is more likely to impair clotting in cardiac surgery, as compared with albumin. “In comparison with crystalloid, HES has also exhibited undesirable effects on coagulation,” while gelatin prolonged clot formation time significantly less than HES in a pediatric surgery trial, the investigators found.

The evidence also indicates that HES, as well as gelatin and dextran, can have adverse renal effects, while albumin was found to be renoprotective. For example, in one study, switching patients with severe pulmonary failure from albumin to HES was associated with a “major” increase in the need for renal replacement therapy, according to the report.

Dr. Wilkes and colleagues say that their findings support the conclusions of a previous systematic review of clinical studies up to 2002. Namely, “Albumin was found to be the safest; whereas, HES and other artificial colloids displayed characteristic adverse effects, notably impaired coagulation and AKI.”

In fact, they add, “Since 2002 the nephrotoxicity of HES has assumed increasing prominence as a safety concern.”

Reference:

Update on the Comparative Safety of Colloids: A Systematic Review of Clinical Studies

Ann Surg 2011.