Page 2252 - Cote clinical veterinary advisor dogs and cats 4th

1120.e2 Hemodialysis

dialysis therapy, and it is never used for other ○ The dialysis catheter is locked with a solu- chronic dialysis in cats. With acute uremia,
indications. tion of concentrated heparin (50-500 U/ dialysis is preferred to determine if renal
function will recover.
mL in cats; 500-5000 U/mL in dogs) or
• Anticoagulation: animals require anticoagula-
VetBooks.ir tion for extracorporeal circulation sodium citrate (4%-46.7%) and protected • Treatment of toxicities: although standard
with a neck bandage until the next
hemodialysis can remove certain toxins,
○ Unfractionated heparin (initial bolus of
50 U/kg IV, followed by a constant-rate
infusion (CRI) of 50 IU/kg/h) is the treatment. addition of charcoal hemoperfusion can
bind additional toxins/drugs. The charcoal
most common anticoagulant used. Target: Postprocedure container is generally inserted into the
doubling of coagulation time (e.g., ACT • Patient assessment: similar to preprocedure extracorporeal blood circuit of the dialysis
160-190 seconds). assessment machine.
○ Regional anticoagulation is indicated • Potential complications: delayed hemor-
for animals with severe hemorrhagic rhage due to systemic heparinization is Pearls
risk, administering trisodium citrate (to possible—avoid needlesticks (IV, IM, • Specialized equipment and training is needed
chelate calcium, an important factor in the SQ), placement or removal of IV catheter, to provide intermittent or continuous
coagulation cascade) in the blood coming or invasive procedures for 12 hours after hemodialysis.
from the animal and calcium (to prevent treatment; monitor neurologic status for • Contact a hemodialysis center early if this
symptomatic hypocalcemia) in the blood dialysis disequilibrium seems a likely potential treatment for patients
returned to the animal • Assessment of adequacy: assessment of quality with AKI.
• Initiation of dialysis therapy of life (attitude, appetite, control of uremic
○ Dialysis machine is equipped with appro- signs); control of hyperkalemia, volume SUGGESTED READING
priate disposables (extracorporeal circuit, overload, and azotemia are monitored with Cowgill LD, et al: Hemodialysis and extracorporeal
hemodialyzer), and its function is tested. each treatment. Kinetic modeling of urea blood purification. In DiBartola SP, editor: Fluid,
○ Dogs are equipped with a harness and removal and generation are more accurate electrolyte, and acid-base disorders in small animal
strapped to the table to loosely restrain methods of determining adequacy of dialysis practice, ed 4, St. Louis, 2012, Saunders, p. 680.
their activity. Cats are provided a box or and should be routinely used.
bed to restrict activity. • Discontinuing therapy: a spontaneous ADDITIONAL SUGGESTED
○ The catheter is connected to the extra- decrease in creatinine or an increase in urine READINGS
corporeal circuit using aseptic techniques, output may signal improvement. When renal Cowgill LD, et al: Extracorporeal renal replacement
and the blood lines are secured to the recovery is suspected, prolongation of the therapy and blood purification in critical care. J
animal’s body to avoid accidental catheter interval between dialysis treatments (i.e., Vet Emerg Crit Care (San Antonio) 23(2):194-204,
removal. As extracorporeal circulation is every third day instead of every other day) 2013.
established, cardiovascular and respiratory allows determination of patient stability Eatroff AE, et al: Long-term outcome of cats and dogs
status is closely monitored. without dialysis. with acute kidney injury treated with intermittent
• Monitoring • Machine maintenance: water purification hemodialysis: 135 cases (1997-2010). J Am Vet
Med Assoc 241(11):1471-1478, 2012.
○ Cardiovascular parameters (heart rate, systems require routine surveillance for infec- Langston CE: Hemodialysis. In Bartges JW, et al,
BP, venous oxygen saturation, relative tion and annual chemical analysis; dialysis editors: Nephrology and urology of small animals.
blood volume change), general condition machines that produce dialysate need clean- Ames, IA, 2011, Wiley-Blackwell, pp 255-285.
(mentation, pupillary light reflexes), anti- ing/rinsing at the end of every treatment and Ross S, et al: Haemodialysis and peritoneal dialysis.
coagulation (ACT), and machine function weekly disinfection; all machines need annual In Elliiott J, et al, editors: BSAVA manual of canine
(extracorporeal blood flow, dialyzer clear- calibration and preventive maintenance. and feline nephrology and urology, ed 3, Ames,
ance) are recorded every 15-30 minutes IA, 2017, Wiley-Blackwell.
for the duration of the treatment. Alternatives and Their AUTHOR: Catherine E. Langston, DVM, DACVIM
○ Initial dialysis treatments commonly neces- Relative Merits EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
sitate additional monitoring, including • Peritoneal or pleural dialysis: does not require Thompson, DVM, DABVP
ECG and pulse oximetry. special equipment
• End of therapy • Renal transplantation: provides continual
○ The circulating blood is returned to the rather than intermittent renal function.
animal, and the disposables are discarded. Preferred for chronic kidney disease over

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