Impact of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model

Witt, Lars; Glage, Silke; Schulz, Katharina; Lichtinghagen, Ralf; Simann, Arne; Pape, Lars; Sümpelmann, Robert

doi:10.1111/pan.12445

Cited by 9 publications

(10 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Coagulopathy and impaired renal function were most often considered contraindications for the use of HES although increased serum creatinine was rarely reported to be an observed adverse effect. This is in accordance with recent studies demonstrating a transient impairment of canine platelet function and whole blood coagulation ( 33 – 37 ) but no effect of HES administration on serum creatinine or urinary biomarkers ( 22 – 25 , 27 ). Although sepsis, severe coagulopathy, intracranial hemorrhage, and impaired renal function are now considered absolute contraindications in many countries for the use of HES in people ( 18 , 19 ), these were mostly considered only relative contraindications by respondents in this survey.…”

Section: Discussionsupporting

confidence: 93%

“…Nevertheless, most of these veterinary studies lacked statistical power due to small sample size, and further research is necessary to elucidate the real scope and severity of HES-related kidney injury in small animals. Only rare reports on renal side effects of gelatins and dextrans in small animals have been published ( 27 ). Recently, in a canine hemorrhagic shock model comparing dogs treated with 6% tetrastarch, 4% gelatin, fresh whole blood, and crystalloids, AKI was observed in all dogs regardless of treatment, with some evidence suggesting greater kidney injury in gelatin-treated dogs ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Current Trends in Volume Replacement Therapy and the Use of Synthetic Colloids in Small Animals—An Internet-Based Survey (2016)

et al. 2017

View full text Add to dashboard Cite

The use of synthetic colloids (SCs), particularly hydroxyethyl starch (HES), in people has changed in recent years following new evidence raising concerns about their efficacy and safety. Although fluid therapy guidelines for small animals are often extrapolated from human medicine, little information exists on current practice in veterinary medicine. The objective of the present study was to investigate current fluid selection, use of plasma volume expanders including SCs, and recent changes in their use in small animal practice. An Internet-based survey was conducted, inviting veterinarians to report their practices in fluid resuscitation and colloid osmotic pressure support, their choice of SC, and perceived adverse effects and contraindications associated with SC use. There were 1,134 respondents from 42 countries, including 46% general practitioners and 38% diplomates. Isotonic crystalloids, HES, and hypertonic saline were chosen by most respondents for fluid resuscitation, and HES by 75% of respondents for colloid osmotic support. Dextran and gelatin were used by some European respondents. Human serum albumin was used more than canine albumin but 45% of respondents, particularly those from Australia and New Zealand, used no albumin product. The majority (70%) of respondents changed their practice regarding SCs in recent years (mostly by limiting their use), largely due to safety concerns. However, only 27% of respondents worked in an institution that had a general policy on SC use. Impaired renal function, coagulopathy, and hypertension were most often considered contraindications; impaired coagulation tests and increased respiratory rate were the most frequently perceived adverse effects. The use of HES remains widespread practice in small animals, regardless of geographic location. Nevertheless, awareness of safety issues and restrictions on the use of SCs imposed in human medicine seems to have prompted a decrease in use of SCs by veterinarians. Given the paucity of evidence regarding efficacy and safety, and differences in cohorts between human and veterinary critical care patients, studies are needed to establish evidence-based guidelines specific for dogs and cats.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Current Trends in Volume Replacement Therapy and the Use of Synthetic Colloids in Small Animals—An Internet-Based Survey (2016)

et al. 2017

View full text Add to dashboard Cite

show abstract

“…However, in about 1000 children who received HES during cardiovascular surgery, no increase of AKI was detectable [ 26 ]. Witt et al used 20 ml/kg HES in a pediatric piglet model and after 7 days, they did not find any relevant impact on renal function [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Balanced Hydroxyethylstarch (HES 130/0.4) Impairs Kidney Function In-Vivo without Inflammation

et al. 2015

View full text Add to dashboard Cite

Volume therapy is a standard procedure in daily perioperative care, and there is an ongoing discussion about the benefits of colloid resuscitation with hydroxyethylstarch (HES). In sepsis HES should be avoided due to a higher risk for acute kidney injury (AKI). Results of the usage of HES in patients without sepsis are controversial. Therefore we conducted an animal study to evaluate the impact of 6% HES 130/0.4 on kidney integrity with sepsis or under healthy conditions Sepsis was induced by standardized Colon Ascendens Stent Peritonitis (sCASP). sCASP-group as well as control group (C) remained untreated for 24 h. After 18 h sCASP+HES group (sCASP+VOL) and control+HES (C+VOL) received 50 ml/KG balanced 6% HES (VOL) 130/0.4 over 6h. After 24h kidney function was measured via Inulin- and PAH-Clearance in re-anesthetized rats, and serum urea, creatinine (crea), cystatin C and Neutrophil gelatinase-associated lipocalin (NGAL) as well as histopathology were analysed. In vitro human proximal tubule cells (PTC) were cultured +/- lipopolysaccharid (LPS) and with 0.1–4.0% VOL. Cell viability was measured with XTT-, cell toxicity with LDH-test. sCASP induced severe septic AKI demonstrated divergent results regarding renal function by clearance or creatinine measure focusing on VOL. Soleley HES (C+VOL) deteriorated renal function without sCASP. Histopathology revealed significantly derangements in all HES groups compared to control. In vitro LPS did not worsen the HES induced reduction of cell viability in PTC cells. For the first time, we demonstrated, that application of 50 ml/KG 6% HES 130/0.4 over 6 hours induced AKI without inflammation in vivo. Severity of sCASP induced septic AKI might be no longer susceptible to the way of volume expansion.

show abstract

“…In conclusion, a relevant impact on renal function was detected neither after moderate (20 ml·kg −1 ) nor after high (50 ml·kg −1 ) doses of HES or GEL in healthy piglets. These results confirm that AKI after HES or GEL is very unlikely in hemodynamically stable perioperative patients with normal renal function.…”

Section: Discussionmentioning

confidence: 62%

“…Furthermore, despite 60 years of clinical practice, renal safety concerns regarding gelatin (GEL), the other widespread artificial colloid used in the pediatric surgical population, are also little explored . Recently, we studied the impact of moderate doses of HES and GEL (20 ml·kg −1 ) on renal function in an established pediatric animal model and did not find any relevant renal side effect. Building on this research, we conducted a second prospective, randomized study with high doses of HES and GEL (50 ml·kg −1 ) in the same pediatric animal model, again hypothesizing that neither the infusion of high doses of HES nor of GEL would significantly affect the renal function of healthy piglets.…”

Section: Introductionmentioning

confidence: 99%

Impact of high doses of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model

Witt

Glage

Lichtinghagen

et al. 2015

Pediatric Anesthesia

Self Cite

View full text Add to dashboard Cite

show abstract

Impact of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model

Cited by 9 publications

References 18 publications

Current Trends in Volume Replacement Therapy and the Use of Synthetic Colloids in Small Animals—An Internet-Based Survey (2016)

Current Trends in Volume Replacement Therapy and the Use of Synthetic Colloids in Small Animals—An Internet-Based Survey (2016)

Balanced Hydroxyethylstarch (HES 130/0.4) Impairs Kidney Function In-Vivo without Inflammation

Impact of high doses of 6% hydroxyethyl starch 130/0.42 and 4% gelatin on renal function in a pediatric animal model

Contact Info

Product

Resources

About