Adverse effects of synthetic colloid fluids in dogs

Corrin J Boyd

Synthetic colloid fluids contain macromolecules that exert colloid osmotic pressure, potentially optimising blood volume expansion for treatment of hypovolaemic shock. In human medicine, use of synthetic colloid fluids has declined. This change is primarily due to research documenting adverse effects of acute kidney injury (AKI) and impaired coagulation, though other adverse effects are reported. Synthetic colloid fluids containing hydroxyethyl starch 130/0.4 (HES) and succinylated gelatin (GELO) are used in canine medicine. The prevalence and relevance of adverse effects in dogs is not well established. This thesis aimed to investigate whether synthetic colloid fluids contribute to AKI and coagulation impairment in dogs with experimental haemorrhagic shock and naturally occurring critical illness. Haemorrhagic shock was experimentally induced in 24 anaesthetized healthy greyhounds. Two synthetic colloid fluids were investigated: HES and GELO. Control fluids were balanced isotonic crystalloid and autologous whole blood. For this model, AKI was assessed with urine and serum biomarkers and renal histology injury scores. There was substantial evidence of AKI with GELO but not HES. Coagulation was assessed with markers of platelet function, whole blood coagulation, and plasma coagulation factors. Both GELO and HES impaired coagulation. A randomized, controlled, clinical trial enrolled 40 hypovolaemic, client-owned dogs. Enrolled dogs were randomized to receive HES or a balanced isotonic crystalloid. A panel of urine AKI biomarkers and clinical AKI scores were measured. There was no association between HES and biomarkers of AKI, though there was substantial variability in the biomarker concentrations between dogs and a low overall incidence of clinically relevant AKI. Coagulation and inflammation were assessed by measurement of plasma coagulation factors and biomarkers of inflammation. There was no association between HES and biomarkers of coagulation or inflammation, though there was also substantial variability of these biomarkers. This thesis found that synthetic colloid fluids were associated with impaired coagulation and AKI in dogs with experimental haemorrhagic shock, with the effects of GELO more pronounced than HES. No evidence of adverse effects was found when HES was investigated in naturally occurring critical illness.

Adverse effects of synthetic colloid fluids in dogs

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