Objective To evaluate the effects of hydroxyethyl starch (HES) on the renal function and blood coagulation of patients with acute pancreatitis (AP). Methods 151 patients with acute pancreatits were divided into treatment group (treated with HES, n=62) and control group (treated with crystalloid solutions, n =89). The two groups were compared by retrospective analysis of the indices such as serum creatinine (Scr), blood urea nitrogen (Bun), platelet count(Plt), prothrombin time activity (PTA), international normalized ratio (INR), activated partial thromboplastin time (APTT) and fibrinogen (FIB) before and after treatment. Results Before hospitalization, there were insignificant differences in respect of Scr and Bun in the two groups respectively. But at discharge, Scr and Bun in the treatment group were significantly increased (P<0.05), while Bun was significantly decreased 24 h right after infusion of crystalloid solutions in the control group (P<0.05). There were no differences between the two groups in terms of Scr and Bun. As for indices of coagulation, APTT in the treatment group was significantly increased after infusion of HES (P<0.05). The hospital stay in the treatment group was longer than the control group (P < 0.05). Conclusions HES may adversely affect renal function and intrinsic pathway of blood coagulation of patients with AP. Renal function and blood coagulation should be monitored when using HES.