Applications and Outcome of Hemodialysis in Cats: A Review of 29 Cases

Abstract

Hemodialysis (HD) has been used in the management of renal failure in dogs, but its feasibility has not been reported for uremic cats. Therefore, we investigated the technical possibility, efficacy, and complications of intermittent HD in cats with severe uremia. A total of 160 HD treatments were performed on 29 cats with acute renal failure (ARF) (n = 15). chronic renal failure (CRF) (n = 6), or acute on CRF (n = 8) between November 1993 and June 1996. Hemodialysis treatments were performed with transcutaneous dialysis catheters using a bicarbonate-based delivery system, sodium modeling, and volumetric-controlled ultrafiltration. Presenting serum chemistries (mean i SD) for all cats were creatinine, 16.4 i-7.5 mg/dL; blood urea nitrogen (BUN), 229 t 87 mg/dL; phosphate, 15.4 t 5.4 mg/dL; potassium, 6.0 t 1.6 mEq/L; and HCO; , 16.0 t 4.4 mEq/L. For intensive HD treatments, pre-HD versus post-HD creatinine changed from 10.3 i 4.4 t o 1.6 2 0.9 rng/dL and BUN from 105 i 33 t o 8 he therapeutic alternatives for acute renal failure (ARF) T or advanced chronic renal failure (CRF) in cats are limited.' Many cats with ARF remain unresponsive to attempts to promote diuresis or die as a result of the metabolic disturbances of uremia before repair of renal damage can occur. Therapy itself may contribute to life-threatening complications that cannot be resolved (eg, overhydration). For cats with end-stage CRF, dietary and conventional medical therapy often is poorly accepted or ineffective, resulting in poor quality of life and owner frustration. Hernodialysis (HD) is the most common form of renal replacement therapy for the majority of human patients with severe uremia. With HD, an artificial kidney alleviates azotemia and life-threatening acid-base, electrolyte, and metabolic disturbances of renal failure by removal of toxic solutes and excessive fluid from the body. The procedure requires reusable access to the vasculature, an effective extracorporeal flow of blood, an artificial kidney (heniodialyzer), and a delivery system to facilitate generation of dialysate and transfer of uremic solutes. Hemodialysis has been successfully employed in dogs with ARF and CRF, but the small size of cats has posed technical hurdles with vascular access, blood delivery, extracorporeal circulation, and hemodynamic stability that precluded its application in this species. The volume of pediatric blood lines and dialyzers suitable for use in dogs approximated the total blood volume of cats. Fluid removal by ultrafiltration was difficult to regulate and monitor accurately on older delivery systems and frequently induced hypovolemia and hypotension. Acetate-based dialysate formulations caused vasodilation and hemodynamic instability with the rapid delivery of acetate to dogs.' The combination of these technical factors led to predictable decreases in blood pressure in experimental and pet dogs treated with HD despite their larger size and made dialysis unsuitable for cats.' Technologic developments and sophistication of dialysis delivery tec...

Technical Management of Hemodialysis Patients

“…4 In recent studies, the reported survival rates for acute kidney injury (AKI) from infectious causes were 58%-100%. [42][43][44] Hemodynamic and metabolic causes of AKI had a 40%-72% survival rate. 44,45 Only 20%-40% of patients with AKI from toxic causes survive.…”

“…44,45 Only 20%-40% of patients with AKI from toxic causes survive. 42,44 Of the patients receiving hemodialysis that do not survive, about half of those die or are euthanatized due to extrarenal conditions (e.g., pancreatitis, respiratory complications). About a third of nonsurvivors are euthanized due to failure of recovery of renal function.…”

Desenvolvimento de um modelo experimental de hemodiálise em cães

“…No presente trabalho utilizou-se perfil de sódio, como proposto por e reafirmado por Langstone et al (1996). Este procedimento possivelmente contribuiu para evitar a ocorrência de episódios hipotensivos, mantendo-se tanto a PAS quanto a PAD estáveis durante as sessões.…”

Development of dialysis disequilibrium‐like clinical signs during postobstructive management of feline urethral obstruction

“…This syndrome has been recognized in both human and veterinary patients undergoing hemodialysis. [3][4][5] Cats with urethral obstruction are often severely azotemic on presentation and therefore have the potential for similar rapid decreases in urea concentrations in the postobstructive period. The purpose of this report is to describe an instance of suspected postobstructive DDS-like clinical signs in a male cat.…”