Page 722 - Fluid, Electrolyte, and Acid-Base Disorders in Small Animal Practice

Hemodialysis and Extracorporeal Blood Purification 709

dialyzed with AKI from toxic causes (especially ethylene threatening poisoning, and fluid overload for which there
glycol ingestion) survive.* This average of 50% survival is no alternative therapy. Nevertheless, its tether to the
has been reported in most studies over the past 15 years clinical mainstream is tenuous and rest on the ongoing
and is a marked improvement from the 15% expected advocacy of its current practitioners to further expand
survival rate from the earliest years of dialysis or for its availability worldwide. Its future development will
survival of animal patients with comparable stages of be secured by ongoing technological advancements in
AKI treated conventionally without hemodialysis. 36,39 its human counterpart. The area that remains most criti-
Of the nonsurviving patients, about half die or are cal and pivotal for the future rests on the comprehensive
euthanized because of extrarenal conditions (e.g., pancre- understanding of its physical and physiologic principles
atitis, respiratory complications, DIC, and financial by those who apply this therapy to animals and the avail-
limitations). About a third of nonsurviving animals are ability of high quality and comprehensive training
euthanized due to failure of recovery of renal function opportunities for the future advocates and practitioners
within a narrow window of time that is dictated usually of this discipline worldwide.
by economic constraints. Ongoing uremic signs, dialysis
complications, and unknown causes account for the
remaining patient deaths. Of surviving patients, approxi- REFERENCES
mately half regain normal renal function (defined by nor-
1. Able JJ, Rowntree LG, Turner BB. On the removal of dif-
mal serum creatinine concentration) and half have
fusible substances from circulating blood of living animals
persistent chronic kidney disease. A clinical scoring sys-
by dialysis. J Pharmacol Exp Ther 1914;5:275–316.
tem for severity and outcome prediction of dogs with 2. Adin CA. Screening criteria for feline renal transplant
AKI receiving hemodialysis has been developed that recipients and donors. Clin Tech Small Anim Pract
may facilitate better characterization of dialysis outcomes 2002;17:184–9.
in the future. 149 3. Adin CA, Cowgill LD. Treatment and outcome of dogs
Studies assessing survival in animals treated with con- with leptospirosis: 36 cases (1990-1998). J Am Vet Med
Assoc 2000;216:371–5.
ventional therapy cannot be compared with those man- 4. Adin CA, Gregory CR, Kyles AE, et al. Diagnostic
aged with dialysis. 36 There are often large disparities in predictors of complications and survival after renal trans-
the severity of the renal injury for animals managed with plantation in cats. Vet Surg 2001;30:515–21.
these respective approaches, and the window for survival 5. Agostoni PG, Marenzi GC. Sustained benefit from ultra-
filtration in moderate congestive heart failure. Cardiology
is finite for animals treated conventionally and indefinite
2001;96:183–9.
for animals treated with dialysis. Severity scoring and 6. Al-Hilali N, Al-Humoud HM, Ninan VT, et al. Profiled
staging of AKI likely will provide more precise under- hemodialysis reduces intradialytic symptoms. Transplant
standing of outcomes in the future. Proc 2004;36:1827–8.
Overall, these observations illustrate hemodialysis has 7. Apsner R, Buchmayer H, Gruber D, Sunder-Plassmann G.
Citrate for long-term hemodialysis: prospective study of
a vital role in the therapeutic stratification of dogs and cats
1,009 consecutive high-flux treatments in 59 patients.
with uremia that remain nonresponsive to conventional Am J Kidney Dis 2005;45(3):557–64.
medical therapy. Hemodialysis improves survival for 8. Arieff AI. More on the dialysis disequilibrium syndrome.
animals with AKI beyond what would be expected with West J Med 1989;151:74–6.
9. Arieff AI. Dialysis disequilibrium syndrome: current
conventional management of the same animals. Clinical
concepts on pathogenesis and prevention. Kidney Int
evidence and experience in human patients suggest a role
1994;45:629–35.
for earlier intervention with renal replacement to avoid 10. Arieff AI, Guisado R, Massry SG, et al. Central nervous
the morbidity of uremia and to promote better metabolic system pH in uremia and the effects of hemodialysis. J Clin
stability and recovery. Invest 1976;58:306–11.
11. Arieff AI, Lazarowitz VC, Guisado R. Experimental dial-
FUTURE OF VETERINARY ysis disequilibrium syndrome: prevention with glycerol.
Kidney Int 1978;14:270–8.
HEMODIALYSIS 12. Arieff AI, Mahoney CA. Pathogenesis of dialysis encepha-
lopathy. Neurobehav Toxicol Teratol 1983;5:641–4.
The establishment of hemodialysis and extracorporeal 13. Bankhead MM, Toto RD, Star RA. Accuracy of urea
therapies in animal patients has had a long and sluggish removal estimated by kinetic models. Kidney Int
1995;48:785–93.
evolution from experimental curiosity to the therapeutic
14. Bayliss G. Dialysis in the poisoned patient. Hemodial Int
mainstream. Currently, hemodialysis stands as a novel and 2010;14(2):158–67.
technically complex therapy with narrowly targeted clini- 15. Bellomo R, Ronco C. Continuous haemofiltration in the
cal indications and regional availability. For a large popu- intensive care unit. Crit Care 2000;4:339–45.
lation of animal patients, it is the advanced standard for 16. Berg RI, Francey T, Segev G. Resolution of acute kidney
injury in a cat after lily (Lilium lancifolium) intoxication.
the management of acute and chronic uremia, life-
J Vet Intern Med 2007;21:857–9.
17. Bernsteen L, Gregory CR, Kyles AE, et al. Renal transplan-
*References 3, 16, 59, 62, 94, 123, 137, 149, 166. tation in cats. Clin Tech Small Anim Pract 2000;15:40–5.