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Does Hetastarch cause acute kidney injury in veterinary medicine? | VETgirl Veterinary Continuing Education Blog

In this VETgirl online veterinary continuing education blog, we interview Dr. Galina Hayes, PhD, DVM, DACVECC, DACVS (Hello, letters!), Assistant Professor in Small Animal Surgery at Cornell University College of Veterinary Medicine. In her recent retrospective study performed at the Ontario Veterinary College, University of Guelph, she evaluated the incidence of acute kidney injury (AKI) and death following hydroxyethyl starch (HES 10% 250/0.5/5:1) administration in dogs (2007-2010). In this retrospective study, the authors evaluated 180 dogs receiving HES compared to 242 random dogs receiving just IV fluids. This is the first veterinary paper evaluating the risk of AKI with HES administration; however, be aware of the limitations of the study (e.g., retrospective, higher cumulative crystalloid dosing differences, higher transfusion rates, etc.). That said, before you reach for a bag of colloids, listen to this VETgirl blog.

A more recent study by Yozova et al called "Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010–2013): 201 dogs" has also been recently published. In this large retrospective study, they found that the use of Hetastarch did not result in increased creatinine concentrations. Obviously, with two studies completely contradicting each other, further studies (especially prospective, blinded studies) are ideally necessary to further evaluate this.

In the meantime, VETgirl still feels comfortable using Hetastarch and other types of colloids, but would limit the use of these colloids to the critically ill patient that does not have evidence of azotemia or renal injury. In other words, if the patient got into a nephrotoxicant or is already azotemic, worth skipping the Hetastarch. But in the non-azotemic patient, it may be worth considering if the colloid osmotic pressure is low.

References:
1. Hayes G, Benedicenti L, Mathews K. Retrospective cohort study on the incidence of acute kidney injury and death following hydroxyethyl starch (HES 10% 250/0.5/5:1) administration in dogs (2007-2010). J Vet Emerg Crit Care 2016;26(1):35-40.
2. Yozova ID, Howard J, Adamik KN. Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010–2013): 201 dogs. J Vet Emerg Crit Care 2016;26(4):568–577.

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