Felis ISSN 2398-2950

Kidney: advanced renal therapies

Synonym(s): Hemodialysis, Intermittent hemodialysis, IHD, continuous hemodialysis, continuous renal replacement therapy, CRRT

Contributor(s): Alina Stefanescu, Alexandru Vitalaru, Stefano Cortellini

Introduction

  • Hemodialysis has been developed for the management of acute Kidney: acute renal failure and chronic renal failure Kidney: chronic kidney disease that is refractory to conventional medical therapy.
  • At the moment, there are two modalities of hemodialysis:
    • Intermittent hemodialysis (IHD) and continuous hemodialysis, or continuous renal replacement therapy (CRRT).
  • Intermittent hemodialysis (IHD) is a renal replacement therapy that is defined by short and efficient hemodialysis sessions with the goal of removing endogenous or exogenous toxins from the bloodstream. IHD is indicated in cases of azotemia Azotemia (which needs to be severe or in case there is worsening of the azotemia over time, eg chronic cases will require IHD but not have an acute azotemia), electrolyte abnormalities (hyperkalemia) or severe acidosis Acid base imbalance unresponsive to medical management.
  • Continuous renal replacement therapy (CRRT) is a continuous process and, once treatment begins, therapy continues for days to weeks until renal function returns or the patient is transitioned to intermittent dialysis. The most common indication for CRRT is the treatment of acute kidney injury (AKI) in cases in which renal function is expected to return in the near future or which can be eventually transitioned to IHD.
  • Prolonged intermittent renal replacement therapy (PIRRT) is another modality which allows rapid treatments over 6-18 hours performed intermittently during the week. This method is used for treatment of AKI cases.

Principles of hemodialysis

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Intermittent hemodialysis (IHD)

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Continuous renal replacement therapy (CRRT)

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Venous access and central venous catheters (CVC)

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Catheter care and management

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Complications

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Further Reading

Publications

Refereed Papers

  • Recent references from VetMed Resource and PubMed.
  • Costea Ruxandra, Vitalaru B A (2015) Propofol induction anesthesia for central venous catheterization in dogs with renal failure. J Biotechnol 208, S42-S43.
  • Stanzani G, Jepson R E, Chan D L (2015) Management of acute kidney injury with continuous venovenous haemodiafiltration in a cat. J Feline Med Surg 17(6), 551-556 PubMed.
  • Acierno M J (2011) Continuous renal replacement therapy in dogs and cats. Vet Clin North Am Small Anim Pract 41(1), 135-146 PubMed.
  • Bloom C A, Labato M A (2011) Intermittent hemodialysis for small animals. Vet Clin North Am Small Anim Pract 41(1), 115-133 PubMed.
  • Chalhoub S, Langston C E, Poeppel K (2011) Vascular access for extracorporeal renal replacement therapy in veterinary patients. Vet Clin North Am Small Anim Pract 41(1), 147-161 PubMed.
  • Claus M A, Jandrey K E, Poppeng R H (2011) Propylene glycol intoxication in a dog. J Vet Emerg Crit Care 21(6), 679-683 PubMed.
  • Stanley S W, Langston C E (2008) Hemodialysis in a dog with acute renal failure from currant toxicity. Can Vet J 49(1), 63 PubMed.
  • Willms L, Vercaigne L (2008) Does warfarin safely prevent clotting of hemodialysis catheters? Semin Dial 21, 71 PubMed.
  • Clark W R, Ronco C (2004) Continuous renal replacement techniques. Contrib Nephrol 144, 264-277 PubMed.
  • Langston C (2002) Hemodialysis in dogs and cats. Compend 24, 540-549.
  • Depner T A (2001) Catheter performance. Semin Dial 14, 425.
  • Elliott D A (2000) Hemodialysis. Clin Tech Small Anim Pract 15, 136-148 PubMed.
  • Bellomo R, Farmer M, Parkin G, Wright C, Boyce N (1995) Severe acute renal failure: A comparison of acute continuous hemodiafiltration and conventional dialytic therapy. Nephron 71(1), 59-64 PubMed.
  • Clark W R, Mueller B A, Alaka K J, Macias W L (1994) A comparison of metabolic control by continuous and intermittent therapies in acute renal failure. J Am Soc Nephrol 4(7), 1413-1420 PubMed.

Other sources of information

  • Centers for Continuous Renal Replacement Therapy can be found at: Nephrology Knowledge: Veterinary Extracorporeal Renal Replacement Unitswww.queenofthenephron.com.
  • Hemodialivet: www.hemodialivet.ro.
  • Groman R (2010) Apheresis in veterinary medicine: therapy in search of a disease. In: Proceedings of the Advanced Renal Therapies Symposium. pp 26-32.
  • West J B (2008) Respiratory physiology: the essentials. Philadelphia: Lippincott Williams & Wilkins. pp 13-73.
  • Johnson C & Simmons W (2006) Dialysis of drugs. Nephrology Pharmacy Associates, Ann Arbor (MI).
  • Cowgill L D, Francey T (2005) Acute uremia. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 6th edn. St. Louis: Elsevier Saunders. pp 1731-1756.
  • Himmelfarb J, Dember LM, Dixon B S (2005) Vascular access. In: Pereira BJ, Sayegh MH, Blake P, editors. Chronic kidney disease, dialysis, transplantation. 2nd ed. Philadelphia: Elsevier Saunders.  p 341.
  • Cowgill L D, Elliott D A (2000) Hemodialysis. In: DiBartola SP (ed) Fluid therapy in Small Animal Practice. 2nd edn. Philadelphia: WB Saunders. pp 528-547.
  • Yeun J, Depner T (2000) Principles of dialysis. In: Dialysis and Transplantation: A Companion to Brenner & Rectors’ the Kidney, Philadelphia WB Sanders, pp 1-32.


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