Starch kidney failure risk

Intensive care doctors should reconsider using a starch fluid to resuscitate patients because it results in higher rates of kidney failure than the alternative saline, researchers say.

In a study of 7000 patients treated in 32 Australian hospitals, researchers from the University of New South Wales' George Institute for Global Health found starch had no clinical benefits over saline.

But patients given starch had a 21 per cent higher risk of kidney failure than those given saline, according to the study published today in The New England Journal of Medicine.

Lead researcher Simon Finfer said starch was widely used overseas and increasingly in Australia, where it was first registered for use in 2008.

Doctors use fluids as a first-line treatment to maintain blood pressure and deliver oxygen and other nutrients to vital organs in acutely ill patients.

Professor Finfer said starch was marketed as being more effective than saline or other fluids on the basis of small studies of its short-term effect on blood pressure and heart rate. But he said little had previously been known about longer-term outcomes in a large patient sample.

The study showed 7 per cent of patients given starch developed kidney failure, compared with 5.8 per cent of those given saline, but found no higher risk of death within three months.

"With patients who are critically ill, there will be a proportion who will develop kidney failure as part of that illness," he said. "But what this tells us is that if we use starch as opposed to saline to resuscitate these patients, more of them will develop kidney failure and need dialysis.

"Approximately 100,000 patients are treated in intensive care units in Australia each year. If everybody got starch, it might result in an extra thousand people having kidney failure."

Professor Finfer said the findings reinforced concerns "that starch is deposited in the kidney and other tissues and might cause kidney injury in that fashion".

He expected doctors worldwide would change their practice in light of the study.

The Austin, Frankston and Western hospitals in Melbourne and the Royal North Shore, St George and Royal Prince Alfred hospitals in Sydney participated in the study.

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