• Galina Hayes, Leontine Benedicenti, and Karol Mathews.
• Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
• J Vet Emerg Crit Care (San Antonio). 2016 Jan 1; 26 (1): 35-40.

ObjectiveTo determine the incidence of in-hospital adverse outcomes including acute kidney injury (AKI) and death in a population of dogs admitted to the intensive care unit (ICU) receiving 10% hydroxyethyl starch (HES) [250/0.5/5:1] compared with the general ICU population, while controlling for illness severity.DesignCohort study conducted between January 2007 and March 2010.SettingVeterinary teaching hospital.AnimalsConsecutive sample of dogs receiving HES (n = 180) were compared with a randomly selected sample of dogs (n = 242) admitted to the ICU over the same period.InterventionsNoneMeasurements And Main ResultsAKI was defined as an at least 2-fold increase in baseline creatinine concentration or new onset of oliguria/anuria persisting for ≥12 hours. The primary outcome was a composite of in-hospital death or AKI. Unadjusted and adjusted analysis controlling for illness severity using the acute patient physiologic and laboratory evaluation (APPLEfast ) score and other confounders was performed. HES was administered either as incremental boluses (median dose 8.2 mL/kg/day, interquartile range [IQR] 5.0-11.3 mL/kg/day) or as a continuous rate infusion (CRI; median dose 26mL/kg/day, IQR 24.0-48 mL/kg/day). In unadjusted analysis, HES administration was associated with increased risk of mortality (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.51-3.58, P < 0.001) or AKI (OR = 3.87, 95% CI = 1.21-12.37, P = 0.02). In an adjusted analysis after controlling for illness severity, admission type, and concurrent administration of blood products, HES administration remained an independent risk factor for the composite adverse outcome (OR = 1.98, 95% CI = 1.22-3.22, P = 0.005), with a number needed to harm (NNH) = 6 (95% CI = 4-23).ConclusionsHES therapy is associated with increased risk of an adverse outcome including death or AKI in dogs. A randomized controlled trial investigating the safety of HES therapy in canine patients is warranted.©Veterinary Emergency and Critical Care Society 2015.

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