Changes in Serum Creatinine Concentration and Acute Kidney Injury (<scp>AKI</scp>) Grade in Dogs Treated with Hydroxyethyl Starch 130/0.4 From 2013 to 2015

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BackgroundHydroxyethyl‐starch (HES) solutions might have renal adverse effects in humans and dogs.ObjectiveTo determine if administration of 6% HES‐130/0.4 is associated with an increase in serum creatinine concentration and development of acute kidney injury (AKI) in nonazotemic cats.AnimalsA total of 62 critically ill cats; 26 HES exposed and 36 unexposed.MethodsRetrospective cohort study (2012–2015). Serum creatinine concentrations were recorded and changes in serum creatinine concentrations before exposure (baseline) and 2–10 and 11–90 days, respectively, were determined. Development of AKI was defined as a > 150% increase or >26 μmol/L increase in serum creatinine concentration from baseline. Risk factors, such as HES administration, cumulative volume of HES (mL/kg) and number of days of HES administration leading to development of AKI, and change in serum creatinine were analyzed.ResultsCats in the HES cohort received a mean volume of 98.5 ± 76.2 mL/kg (range, 8–278 mL/kg) HES over a median of 4 (range, 1–11) days, resulting in a median dose of 20.1 (range, 8–40.5) mL/kg per day. Short‐term %change in serum creatinine concentration (P = 0.40) and development of AKI (P = 0.32) were not significantly different between cohorts. Multivariable logistic regression did not identify HES dose in mL/kg (P = 0.33) and number of days of HES application (P = 0.49) as a risk factor for development of AKI.Conclusion and Clinical ImportanceHydroxyethyl‐starch administration to critically ill nonazotemic cats seems to be safe. A larger prospective study is required to determine the effect of HES administration at higher dosages and for prolonged time periods.

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 61%

mentioning

confidence: 99%

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Effects of Hydroxyethyl Starch 130/0.4 on Serum Creatinine Concentration and Development of Acute Kidney Injury in Nonazotemic Cats

Sigrist

Kälin

Dreyfus

2017

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“…Categories for presenting clinical signs and clinicopathologic abnormalities (based on the performed diagnostic tests) are described in Table . All dogs with renal disease had resolution of azotemia after initiation of treatment, and their renal disease was retrospectively graded (solely by serum creatinine concentration) according to International Renal Interest Society (IRIS) guidelines for acute kidney injury (AKI) …”

Section: Methodsmentioning

confidence: 99%

Comparison of two melphalan protocols and evaluation of outcome and prognostic factors in multiple myeloma in dogs

Fernández

Chon

2018

BackgroundMultiple myeloma (MM) in dogs typically is treated with melphalan. A daily melphalan dosing schedule reportedly is well tolerated and associated with favorable outcome. Although anecdotally a pulse dose regimen has resulted in successful responses, little long‐term outcome and safety data is available regarding this dosing regimen for dogs with MM.Hypothesis/objectives(1) To compare outcome and adverse event profiles between pulse dose and daily dose melphalan schedules and (2) to report prognostic factors in dogs with MM treated with melphalan. We hypothesized that both protocols would have similar outcomes and tolerability.AnimalsThirty‐eight client‐owned dogs diagnosed with MM receiving pulse dose (n = 17) or daily dose (n = 21) melphalan.MethodsRetrospective cohort study assessing outcome and adverse events in dogs receiving either protocol. Risk factors were evaluated for their prognostic relevance.ResultsBoth regimens were well tolerated and similarly effective, with an overall median survival time of 930 days. Renal disease and neutrophil‐to‐lymphocyte ratio (NLR) were negative prognostic factors, whereas hypercalcemia and osteolytic lesions were not prognostic factors in this study population.Conclusions and Clinical ImportancePositive results support the use of either dosing regimen for the treatment of dogs with MM, and renal disease and NLR were negative prognostic factors. Prospective, controlled, and randomized studies are warranted to confirm these findings.

“…Acute kidney injury is gaining attention in small animal medicine, but universally accepted diagnostic criteria are lacking . Recently, an AKI grading system for dogs was proposed by Cowgill, accepted by the IRIS group (http://www.iris-kidney.com/pdf/grading-of-acute-kidney-injury.pdf), and applied in clinical settings . Diagnostic criteria and five AKI grades based on medical data, sCr concentrations, and UO are suggested.…”

Section: Introductionmentioning

confidence: 99%

Fractional excretion of electrolytes in volume‐responsive and intrinsic acute kidney injury in dogs: Diagnostic and prognostic implications

Troìa

Gruarin

Grisetti

et al. 2018

BackgroundThe value of fractional excretion (FE) of electrolytes to characterize and prognosticate acute kidney injury (AKI) is poorly documented in dogs.ObjectivesTo evaluate the diagnostic and prognostic roles of FE of electrolytes in dogs with AKI.AnimalsDogs (n = 135) with AKI treated with standard care (February 2014‐December 2016).MethodsProspective study. Clinical and laboratory variables including FE of electrolytes, were measured upon admission. Dogs were graded according to the AKI‐IRIS guidelines and grouped according to AKI features (volume‐responsive, VR‐AKI; intrinsic, I‐AKI) and outcome (survivors/non‐survivors). Group comparison and regression analyses with hazard ratios (HR) evaluation for I‐AKI and mortality were performed. P < .05 was considered significant.ResultsFifty‐two of 135 (39%) dogs had VR‐AKI, 69/135 (51%) I‐AKI and 14/135 (10%) were unclassified. I‐AKI dogs had significantly higher FE of electrolytes, for example, FE of sodium (FENa, %) 2.39 (range 0.04‐75.81) than VR‐AKI ones 0.24 (range 0.01‐2.21; P < .001). Overall, case fatality was 41% (55/135). Increased FE of electrolytes were detected in nonsurvivors, for example, FENa 1.60 (range 0.03‐75.81) compared with survivors 0.60 (range 0.01‐50.45; P = .004). Several risk factors for death were identified, including AKI‐IRIS grade (HR = 1.39, P = .002), FE of electrolytes, for example, FENa (HR = 1.03, P < .001), and urinary output (HR = 5.06, P < .001).Conclusions and Clinical ImportanceFractional excretion of electrolytes performed well in the early differentiation between VR‐AKI and I‐AKI, were related to outcome, and could be useful tools to manage AKI dogs in clinical practice.