Peritoneal Dialysis in Cats with Acute Kidney Injury: 22 Cases (2001–2006)

Abstract

Background: Peritoneal dialysis (PD) has been described for use in animals with acute kidney injury refractory to fluid therapy. However, no study has examined the use of PD in a large group of cats.Hypothesis: PD is an important adjunctive therapy to treat acute kidney injury in cats. Animals: The medical records of 22 cats with acute kidney injury that had received PD were examined. Animals were excluded if acute uremia was a result of postrenal causes such as uroabdomen or urethral obstruction.Methods: Medical records were reviewed for the following: indication for PD, outcome, number of cycles performed, survival time, and predialysis and postdialysis results for blood urea nitrogen (BUN), creatinine, potassium, chloride, sodium, phosphorus, total protein, and albumin concentrations, and urine output.Results: Indications for PD include acute-on-chronic kidney injury, acute kidney injury caused by toxins, bilateral ureteroliths, bilateral ureteral ligation as a complication of ovariohysterectomy, and unknown causes. The median survival time for all cats on PD was 4 days, although the median survival time for the cats that were discharged was 774 days. The most common complications were dialysate retention and sequestration of dialysate SC. There was a significant (Po .05) decrease between predialysis and postdialysis results for BUN, creatinine, potassium, phosphorus, total protein, and albumin concentrations. There was a significant (Po .05) difference in survival times between sexes.Conclusions and Clinical Importance: PD is an effective option for treatment of cats with acute kidney injury refractory to fluid therapy.

Expression of Kidney Injury Molecule-1 in Healthy and Diseased Feline Kidney Tissue

“…Several causes of fulminant kidney injury are recognized, such as urethral obstruction, exposure to certain drugs, and ingestion of ethylene glycol and Lilium sp. 23,28,29,43,66 In an effort to more sensitively detect AKI, it was suggested by the International Renal Interest Society (IRIS) to adopt a scoring system for AKI in animals similar to that in humans. 24 The suggested scoring system incorporates small increases in SCC irrespective of reference intervals (RIs) and reduced urine output.…”

Peritoneal Dialysis

“…23 In another study 16% of cats developed hypoalbuminemia. 21 Hypoalbuminemia may be the result of low dietary protein intake, gastrointestinal or renal protein loss, loss into the dialysate itself as a result of chronic inflammatory changes in the peritoneum, uremic catabolism, and concurrent diseases. Usually the animal can maintain a normal serum albumin concentration if nutritional intake is adequate.…”

“…29 In recent studies at our institution, peritonitis was not identified in any of the PD cases in dogs reviewed during a 4-year period and was reported in only 1 of 22 cats (2.5%) over a 5-year period. 21,30 The most common source of peritonitis is contamination of the bag spike or tubing by the handler, although intestinal, hematogenous, and exit site sources of infection do occur. 29 It is important to recognize pericatheter leaks to minimize exit site sources of infection.…”

“…A total of 62% of cats with percutaneously placed catheters experienced subcutaneous leakage and 50% of cats with surgically placed catheters had subcutaneous leakage. 21 Dialysate leakage can be minimized by ensuring a closely apposed abdominal incision closure (simple interrupted suture pattern only), starting the initial exchange volumes at a quarter of the calculated infusion amount, and if leakage does occur, intermittently wrapping the limbs to promote mobilization of the edema. Additionally, if subcutaneous leakage occurs, the dialysate solution should be changed to the lowest possible osmolality formulation available; otherwise the hyperosmolar glucose solution in the dialysate will continue to bring body water with it into the subcutaneous tissue.…”

Peritoneal Dialysis

“…Such toxins include ethylene glycol, ethanol, and barbiturates. 16 One study of PD for the treatment of leptospirosis in five dogs reported a survival rate of 80%. PD with hypertonic dialysate can be used to remove excess body water in animals with life-threatening fluid overload, such as may occur with heart failure.…”