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Acute kidney in dogs after hydroxyethl starch 130/0.4 or Hartmann's Solution: Protocol and feasibility analysis

Boyd, C.J.ORCID: 0000-0003-1361-2148, Claus, M.A.ORCID: 0000-0003-1529-1480, Sharp, C.R.ORCID: 0000-0002-1797-9783, Raisis, A.L., Hosgood, G.L. and Smart, L.ORCID: 0000-0003-4776-2849 (2018) Acute kidney in dogs after hydroxyethl starch 130/0.4 or Hartmann's Solution: Protocol and feasibility analysis. In: 26th International Veterinary Emergency and Critical Care Symposium (IVECCS) 2018, 14 - 18 September 2018, New Orleans, LA, USA.

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Introduction: Hydroxyethyl starch (HES) has been associated with acute kidney injury (AKI) in people, but there is limited evidence in dogs. We present the protocol and feasibility analysis of an ongoing prospective randomized blinded phase II clinical trial.

Methods: Dogs at a university hospital prescribed a fluid bolus for clinical reasons were randomized to receive at least 10 mL/kg of HES 130/0.4 or Hartmann's solution. After 40 mL/kg of study fluid further fluid administration was open‐label. Urine for neutrophil gelatinase‐associated lipocalin and cystatin C was collected prior to and 6, 12, and 24 hours after the first study fluid bolus. Serum creatinine was measured daily for 7 days or until discharge. Target sample size was 20 per group. Screening and enrolment targets were 7 and 2 per week, respectively. Population characteristics and feasibility outcomes for the first 17 weeks of enrolment are reported.

Results: Thirty‐six dogs were logged as screened (2.1 per week) with 15 enrolled (0.9 per week). Reasons for exclusion included dehydration (4/21), transfusion required (4/21), consent declined (3/21), insufficient time to enroll (2/21), and predicted hospitalization < 24 hours (2/21). Twelve out of 15 dogs that were enrolled were administered the intervention. One was taken home against medical advice, one was administered a transfusion in place of the intervention, and one no longer required the intervention. For the 12 dogs administered the intervention, median (range) APPLEfast score was 23.5 (20–38) and 4 were septic. Median (range) volume of intervention fluid was 22.9 mL/kg (10.0–57.1 mL/kg). There were four major protocol violations, all relating to volume of intervention fluid administered. Nine of 12 dogs completed blood and urine sampling for all time points. Two out of 12 dogs developed AKI during hospitalization based on Veterinary Acute Kidney Injury scoring (one stage 1, one stage 2). Nine out of 12 dogs survived to discharge (2 died, 1 euthanized due to prognosis).

Conclusion: Recruitment rate was lower than projected, mainly due to lower number of dogs screened. The investigators are satisfied that the enrolled cases are representative of the population of clinical interest. Drop‐out after enrolment and protocol violations highlight the challenges of performing clinical interventional studies in emergency medicine.

Item Type: Conference Item
Murdoch Affiliation: School of Veterinary and Life Sciences
Publisher: Wiley
Copyright: © Veterinary Emergency and Critical Care Society 2018
Other Information: Winner of the Veterinary Emergency and Critical Care Foundation Research Grant.
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