Keynote Message

Until now, no official guidelines or consensus statement are available about the handling and use of hydroxyethyl starch (HES) or other synthetic colloids in small or large animals. However, according to an international survey in small animal medicine from May 2016 performed by the author, besides crystalloids, HES preparations were used by a high percentage of the respondents for fluid resuscitation and shock, as well as for colloid osmotic pressure support (unpublished data). Only a small percentage of veterinarians are using gelatin or dextran products. It is therefore of importance to elucidate the effects and side effects of HES in companion animals. The two most investigated side effects in small animals are impairment of global haemostasis and acute kidney injury (AKI).¹

According to the available literature on haemostasis impairment, HES preparations lead to a significant impairment of platelet function and coagulation.^2-6 By using viscoelastic methods in some of the studies, a better characterization of the specific effect on clot formation is possible, revealing a prolonged clot formation speed, a reduced fibrin polymerization, and a decreased clot strength. Notably, no effect beyond dilution with the comparator fluid could be demonstrated by some investigators, and in several in vivo studies the effects of HES were only short lived (some hours).^4-7

Studies investigating potential adverse renal effects of HES solutions are rare in dogs and cats. Most of them are retrospective and based on the evaluation of change in creatinine concentrations. Four retrospective studies could not demonstrate AKI after administration of 6% HES 130/0.4 in dogs or cats,^8,9 whereas one study found HES therapy to be associated with increased risk of death or AKI in dogs receiving 10% HES-250/0.5¹⁰.

In this session, the existing evidence about synthetic colloids, mainly HES, will be discussed.

Keynote References

1.  Adamik KN, Yozova ID, Regenscheit N. Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care. J Vet Emerg Crit Care.2015;25:20–47. DOI: 10.1111/vec.12283.

2.  Albrecht NA, Howard J, Kovacevic A, et al. In vitro effects of 6% hydroxyethyl starch 130/0.42 solution on feline whole blood coagulation measured by rotational thromboelastometry. BMC Vet Res. 2016;12:155. DOI: 10.1186/s12917-016-0767-8.

3.  Classen J, Adamik KN, Weber K, et al. In vitro effect of hydroxyethyl starch 130/0.42 on canine platelet function. Am J Vet Res 2012;73:1908–1912. DOI: 10.2460/ajvr.73.12.1908.

4.  McBride D, Hosgood G, Raisis A, et al. Platelet closure time in anesthetized Greyhounds with hemorrhagic shock treated with hydroxyethyl starch 130/0.4 or 0.9% sodium chloride infusions. J Vet Emerg Crit Care.2016;26:509–515. DOI: 10.1111/vec.12468.

5.  Reuteler A, Howard J, Axiak Flammer S, et al. Comparison of a balanced versus a saline-based tetrastarch on canine whole blood coagulation and platelet function. J Vet Emerg Crit Care 2014;24:S27 (abstract presented at the 13th annual European Emergency and Critical Care Congress, Prague, Czech Republic, June 2014). Published in 2017 in J Vet Emerg Crit Care. 2017;27(1):23-34: www.ncbi.nlm.nih.gov/pubmed/27926787. doi: 10.1111/vec.12556.

6.  Wurlod VA, Howard J, Francey T, et al. Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs. J Vet Emerg Crit Care 2015;25:474–487. DOI: 10.1111/vec.12320.

7.  Gauthier V, Holowaychuk MK, Kerr CL, et al. Effect of synthetic colloid administration on coagulation in healthy dogs with systemic inflammation. J Vet Intern Med 2015;29:276–285. DOI: 10.1111/jvim.12492.

8.  Yozova ID, Howard J, Adamik KN. Effect of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in cats: a retrospective analysis (2010–2015). J Feline Med Surg. 2016. DOI: 10.1177/1098612X16676160.

9.  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;26:568–577. DOI: 10.1111/vec.12483.

10. 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;26:35–40. DOI: 10.1111/vec.12412.