Hemodialysis and Extracorporeal Blood Purification

Cowgill, Larry D; Francey, Thierry

doi:10.1016/b978-1-4377-0654-3.00036-6

Cited by 28 publications

(58 citation statements)

References 149 publications

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“…Common complications associated with HP are thrombocytopenia, leukopenia, hypocalcemia, hypoglycemia, and hypothermia 9 . Many of the complications seen with HP are eliminated by performing HP/HD 9,10 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick

Messenger

Vigani

2020

J Vet Emergen Crit Care

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Objective To describe the efficacy of in‐series hemoperfusion and hemodialysis in 2 dogs with carprofen overdose. Case Summary This report describes the treatment of 2 dogs following accidental carprofen overdoses who underwent a single in‐series hemoperfusion and hemodialysis session. Serial serum carprofen concentrations were measured before, during, and after the session. The first patient's session lasted 5 hours, with the largest decrease in serum carprofen concentrations occurring during the first hour of treatment. The carprofen clearance during the following 4 hours of treatment decreased substantially compared to the first hour and was not different from the patient's intrinsic clearance of carprofen after the session was completed. Based on the findings from the first case, the second patient was treated with a 1 hour single hemoperfusion and hemodialysis session. Our results support the hypothesis that carprofen is not effectively removed by conventional hemodialysis and the efficacy of hemoperfusion is short lived due to rapid saturation of the charcoal filter. Once filter saturation occurs, the extracorporeal session is no longer efficacious. Using in‐series hemoperfusion and hemodialysis is of benefit to correct the side effects seen with hemoperfusion alone, and hourly charcoal filter replacement may extend the efficacy of treatment in removing carprofen. New or Unique Information Provided This is the first published report of in‐series hemoperfusion and hemodialysis being used to treat carprofen overdose in a dog. In these 2 cases, the intrinsic clearances of the patients were shown to be equivalent to that of standard hemodialysis alone, indicating that hemodialysis does not produce any advantage in carprofen clearance. In this limited report, we suggest that the efficacy of hemoperfusion in removing carprofen is short‐lived, and extending the treatment beyond the first hour does not produce any therapeutic benefit. In order to extend the efficacy of hemoperfusion, hourly replacement of the charcoal filter should be considered.

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Section: Introductionmentioning

confidence: 99%

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Fick

Messenger

Vigani

2020

J Vet Emergen Crit Care

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“…Main indications include immune‐mediated diseases, hyperviscosity syndrome and toxicosis caused by highly protein‐bound solutes . Aside from the older manual centrifugation, 2 main modern techniques have been developed to separate the plasma from the blood circulating in an extracorporeal circuit: continuous flow centrifugation‐based TPE (cTPE) and membrane filtration TPE (mTPE) . Although the cTPE platforms offer the possibility of other apheresis techniques such as red cell, white cell, or platelet apheresis, they require specific machines that are only available in few specialized institutions.…”

Section: Introductionmentioning

confidence: 99%

Membrane‐based therapeutic plasma exchange in dogs: Prescription, anticoagulation, and metabolic response

Francey

Schweighauser

2019

Veterinary Internal Medicne

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Background Therapeutic plasma exchange (TPE) is used increasingly in small animals to remove circulating large molecular products such as antibodies, pathogenic proteins, and protein‐bound toxins. Specific, efficient, and safe protocols need to be developed. Hypothesis/Objectives To describe the technique of membrane‐based TPE, the resulting physiological and metabolic changes, and to define an adequate regional citrate anticoagulation protocol. Animals Thirty‐four dogs treated with TPE (2011‐2017). Methods Retrospective review of all TPE treatments performed at the Vetsuisse Faculty, University of Bern, identified through a search of the institutional database for extracorporeal treatments. Results Sixty‐four treatments were performed, resulting in 1.0 plasma volume exchange (range, 0.4‐1.1). Replacement fluids included fresh frozen plasma (12%‐100% volume), colloids (0%‐52%), human albumin (0%‐41%), and saline (0%‐70%). Anticoagulation was performed with regional citrate (n = 24), systemic heparinization (n = 2), or combined (n = 38). Main relevant laboratory changes included a 24.7% decrease in total proteins (interquartile range, 16.7‐31.4; P < .001), 53% in fibrinogen (−30 to 63; P = .009), 36% in bilirubin (13‐43, P = .02), 9.0% in urea (0.7‐15.7; P < .001), and 4.5% in creatinine (−6.6 to 10.6; P = .006). Citrate accumulation was evidenced in all dogs, more pronounced in those with renal but not with hepatic impairment. Maximal tolerable citrate rates were estimated as 5.5 and 9.0 μmol/kg/min for treatments in dogs with and without renal impairment, respectively. Complications were observed in 22 treatments (34%) and were fatal in 2 dogs. Conclusions and Clinical Importance Therapeutic plasma exchange causes metabolic and biochemical alterations. Understanding these effects makes possible to anticipate most complications and to improve safety of the procedure.

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“…Veno‐venous intermittent HD was performed with a Gambro AK200 UltraS system d. The dialysis prescription was tailored and adjusted to the needs of the dogs, according to recommended protocols . The extracorporeal circuit consisted of blood tubinge and dialyzersf chosen mostly based on their priming volumes and membrane characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…Regional anticoagulation techniques limited to the blood in the extracorporeal circulation have been developed for human patients treated with continuous renal replacement therapies . In these techniques, the blood coming from the patient is anticoagulated, and this process is reversed in the returning blood, so that the blood circulating in the body has normal hemostatic characteristics.…”

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confidence: 99%

“…1,2 Heparin infusion rate is based on clinical assessment of evidence or risk of bleeding, and it is adjusted based on coagulation monitoring every 30-60 minutes during the treatment, with a goal to approximately double the coagulation time at baseline. 1 Systemic anticoagulation, however, can worsen existing bleeding lesions frequently encountered in the setting of acute kidney injury (AKI). 3 Disseminated intravascular coagulation, gastro-intestinal ulcerations, or leptospirosis-associated pulmonary hemorrhages can deteriorate rapidly with a potentially fatal outcome.…”

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confidence: 99%

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Regional Citrate Anticoagulation for Intermittent Hemodialysis in Dogs

Francey

Schweighauser

2017

Veterinary Internal Medicne

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BackgroundThe traditional systemic heparinization used for anticoagulation in extracorporeal therapies may cause fatal complications in animals at risk of bleeding.Hypothesis/ObjectivesTo develop and validate a protocol of regional citrate anticoagulation (RCA) for intermittent hemodialysis in dogs.AnimalsA total of 172 dogs treated with hemodialysis for acute kidney injury.MethodsIn vitro titration was performed, adding trisodium citrate and calcium chloride to heparinized canine blood. A tentative protocol was used first in 66 treatments with additional heparinization and subsequently in 518 heparin‐free treatments. Safety and adequacy of RCA were assessed based on clinical and laboratory monitoring, dialyzer pressure gradient, treatment completion, and visual scoring of the extracorporeal circuit.ResultsAddition of 1 mmol/L citrate to heparinized blood decreased the ionized calcium concentration by 0.23 mmol/L (95% confidence interval [CI], 0.16–0.30) and 1 mmol/L calcium increased it by 0.62 mmol/L (95% CI, 0.45–0.79). Heparin‐free treatments were initiated with infusion of trisodium citrate (102 mmol/L) at 2.55 mmol/L blood and calcium chloride (340 mmol/L) at 0.85 mmol/L. Citrate and calcium administrations were adjusted in 27 and 34% of the treatments, respectively. Overall, anticoagulation was satisfactory in 92% of the treatments, with expected azotemia reduction in 95% (urea) and 86% (creatinine), stable dialyzer pressure gradient in 82%, and clean extracorporeal circuits in 92% of the treatments. Eighteen treatments (3.5%) were discontinued prematurely, 9 because of clotting and 9 for reasons unrelated to the RCA procedure.Conclusions and Clinical ImportanceRegional citrate anticoagulation allows safe and efficient heparin‐free hemodialysis in dogs at risk of bleeding.

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Hemodialysis and Extracorporeal Blood Purification

Cited by 28 publications

References 149 publications

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Efficacy of a single session in‐series hemoperfusion and hemodialysis in the management of carprofen overdose in two dogs

Membrane‐based therapeutic plasma exchange in dogs: Prescription, anticoagulation, and metabolic response

Regional Citrate Anticoagulation for Intermittent Hemodialysis in Dogs

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