The review by Boldt 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, kidney dysfunction, pruritus, and tissue storage with risk of organ failure. 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. Renal lesions persist for many years, but prospective data on HES 130/0.4 is derived mainly from short perioperative studies in low-risk patients and with low cumulative doses.
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