Is the literature inconclusive about the harm of HES? We are not sure

Excerpt

Intravenous hydroxyethyl starch (HES) solutions were introduced for clinical use about 50 years ago without extensive clinical assessment, and this is also the case for the other currently available IV fluid solutions. HES solutions found widespread acceptance because, when compared with crystalloids, their use is associated with a superior volume effect resulting in faster hemodynamic stability with less total volume, and thus a less-positive fluid balance [1]. Experimental data also showed positive effects on the microcirculation and attenuated inflammation. In addition, starch solutions are cheaper than albumin and they have longer shelf lives. Small studies with older HES molecules suggested renal toxicity, impaired coagulation, and long-term retention in the reticuloendothelial system [2]. The nephrotoxicity has been related to their storage in tubular cells (osmotic nephrosis) [3]. The modern tetrastarches were supposed to be devoid of these toxic side effects because of their lower average molecular weight, degree of substitution, and concentration. Recent trials have challenged this assumption, however. …