Prospective randomized controlled blinded clinical trial evaluating biomarkers of acute kidney injury following 6% hydroxyethyl starch 130/0.4 or Hartmann's solution in dogs. Issue 3 (12th March 2021)

• Record Type: Journal Article
• Authors: Boyd, Corrin J.; Sharp, Claire R.; Claus, Melissa A.; Raisis, Anthea L.; Hosgood, Giselle; Smart, Lisa
• Is Part Of: Journal of veterinary emergency and critical care. Volume 31:Issue 3(2021)
• Page Start: 306
• Page End: 314
• Publication Date: 2021-03-12
• Subjects: clusterin -- cystatin C -- fluid therapy -- kidney injury molecule‐1 -- neutrophil gelatinase‐associated lipocalin -- osteopontin; Veterinary emergencies -- Periodicals; Veterinary critical care -- Periodicals; 636.089
• DOI: 10.1111/vec.13056
• Languages: English
• ISSNs: 1479-3261

Abstract

Abstract: Objective: To evaluate the effect of 6% hydroxyethyl starch (HES) 130/0.4, compared with a Hartmann's solution control (CRYST), on urine biomarkers of acute kidney injury (AKI) in dogs prescribed a fluid bolus. Design: Randomized, controlled, blinded clinical trial January 2018 to February 2019. Setting: University teaching hospital. Animals: Forty client‐owned dogs. Interventions: Dogs prescribed a fluid bolus were randomized to receive at least 10 mL/kg of HES or CRYST with clinicians and investigators blinded to fluid type. Study fluid was used for further boluses as required in the following 24 hours, to a limit of 40 mL/kg total, after which fluid administration was open‐label. Measurements and Main Results: Urine was collected prior to and 6, 12, and 24 hours after the first study fluid bolus. Urine concentrations of AKI biomarkers: neutrophil gelatinase‐associated lipocalin (NGAL), cystatin C, kidney injury molecule‐1 (KIM), clusterin, and osteopontin were measured using a magnetic bead multiplexed assay. Osmolality‐indexed biomarker concentrations were compared between groups over time with linear mixed‐effects models, with P < 0.05 considered significant. The mean volume of study fluid administered was not significantly different between groups (HES: 23.1 mL/kg, CRYST: 25.9 mL/kg; P = 0.47, t‐ test). There were no significant differences between groups in change over time of osmolality‐indexed urine concentrations of NGAL ( P = 0.91), cystatin C ( P = 0.95), KIM ( P = 0.77), clusterin ( P = 0.63), or osteopontin ( P = 0.91). The maximum Veterinary Acute Kidney Injury (VAKI) score up to 7 days during hospitalization ( P = 1.0) and in‐hospital mortality ( P = 0.49) were not significantly different between groups, as compared by Fisher's exact test. Conclusions: There were no differences in change over time of urine AKI biomarkers in dogs treated with 10 – 40 mL/kg HES or CRYST over 24 hours. Larger clinical trials with patient‐centered outcomes are required to investigate the safety of HES in dogs.