Page 681 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

668 SPECIAL THERAPY

BOX 28-1 Comparison of Clinical renal failure of varying causes reported survival in
five of the six cats, all of which eventually had
Use of Hemodialysis normal renal parameters. All cats had complications,
and Peritoneal Dialysis including subcutaneous edema (83%), hyperglycemia
(67%), dialysate retention (50%), and hypoalbuminemia
Hemodialysis (50%). 22
• More efficacious in altering water and solute balance The success rate of PD must be compared with the
• Requires expensive equipment and supplies overall survival rate of animals with acute renal failure
• Requires a high level of technological expertise treated with other means because animals undergoing
dialysis traditionally have been those with the most severe
Peritoneal Dialysis
renal failure. The survival rate of dogs with leptospirosis
• More efficacious in removing uremic middle molecules
treated with fluids and antibiotics has been reported to
• Technologically simple 1,33,54
be 59% to 85%. In a study of 99 dogs with acute
• Labor intensive
renal failure, 43% were discharged from the hospital. Of
these, 24% were left with residual renal dysfunction,
and only 19% had return to normal renal function. 69
In another report of 80 dogs with acute renal failure, only
BOX 28-2 Indications for Acute 20% survived to discharge; 44% of the dogs had ethylene
30
Peritoneal Dialysis glycol intoxication. It may be that the survival of
animals with acute kidney injury treated with PD is
more dependent on the underlying cause of disease than
Oliguric or anuric acute renal failure the technique.
Acute renal failure associated with nonresponsive uremia PD could theoretically be used for the long-term
Postrenal failure management of animals with chronic renal failure.
Ureteral obstruction
However, technical problems with catheter flow and
Rupture in urine collecting system
Removal of dialyzable toxins complications such as infection make chronic PD
12,20,58,62,67
Ethylene glycol difficult. Few such cases have been reported.
Ethanol
Barbiturates
Volume overload CONTRAINDICATIONS TO
Hypercalcemia PERITONEAL DIALYSIS
Hyperkalemia
Hypothermia There are few situations in which PD is absolutely
Hyperthermia caused by heatstroke contraindicated. In humans, these include peritoneal
Pancreatitis
adhesions that prevent fluid distribution throughout
the abdominal cavity and pleuroperitoneal leaks that
would result in pleural effusion and respiratory com-
promise. Although adhesions are common in humans,
improvement in renal function during dialysis, overall especially those that have had abdominal surgery, 13
survival remained poor. More recent publications they are not often seen in dogs and cats. Diaphragmatic
reported improved survival, perhaps indicating an or pericardiodiaphragmatic hernias are seen in animals
improvement in technique or overall management of crit- and could result in respiratory or cardiac dysfunction.
ically ill animals. In one study of 27 dogs and cats, 24% That said, pleural dialysis has been described in two
improved and were discharged from the hospital. 20 How- dogs with acute renal failure. 60 Relative contrain-
ever, 11 of 21 of the animals with acute renal failure suf- dications for PD include recent thoracic or abdominal
fered from ethylene glycol intoxication, which is known surgery, inguinal or abdominal hernias, and severe
to result in a mortality rate approaching 100%. 30,69 In hypercatabolic states, such as those seen with cutaneous
another study, 45% (10 of 22) of cats treated with PD burns or skin denudation. Animals with recent abdom-
were discharged from the hospital. 16 One study of PD inal surgery, especially gastrointestinal surgery, are at
for the treatment of leptospirosis in five dogs reported risk for dehiscence and infection during PD because
a survival rate of 80%. 9 Complications identified in of the increased abdominal pressure and potential fluid
these dogs were hypokalemia (60%), hypoalbuminemia leakage through the incision site. Similarly, progressive
(40%), hypomagnesemia (20%), pelvic limb edema herniation may occur as the result of increased
(40%), central nervous system signs (40%), dialysate intraabdominal pressure. Concomitant catabolic
retention (20%), and leakage from the catheter site diseases contribute to the hypoalbuminemia that can
(20%). A report of six cats treated with PD for acute occur during PD.