Hemodialysis for Pets on Long Island
Over the last decade, the number of universities and specialty practices offering hemodialysis has expanded. Despite this, hemodialysis remains unavailable to most veterinary patients.
VMCLI is proud to be able to offer hemodialysis services on Long Island.
With acute kidney injury, the most common use of hemodialysis in veterinary patients, hemodialysis extends the window of opportunity for renal repair indefinitely. While dialysis is unable to fix the kidney injury, it can provide the damaged kidney with time to repair itself.
While the reasons and benefits of hemodialysis are well established, the exact timing of the initiation of dialysis is vital for the best outcomes. It needs to be considered on a case-by-case basis.
If your primary vet determines that your pet may benefit from hemodialysis, please request a referral to our dedicated team.
Advanced Technology For Kidney Care
At the Veterinary Medical Center of Long Island, we have advanced tools to help diagnose conditions that may be preventing your dog or cat's kidneys from working properly. Our equipment can help us diagnose your pet's condition quickly and offer life-saving treatment as soon as possible.
What is Hemodialysis?
Hemodialysis is the process of exchanging water, solutes, and toxins across a semipermeable membrane which acts as an artificial kidney.
This allows for the removal of waste products and toxins from the blood and restoration of the patient’s electrolyte and acid-base derangements from the dialysate water.
During dialysis, excess water, select solutes and toxins pass through the small pores in the artificial kidney, but larger solutes, proteins, and cells are retained in the patient due to the small size of the pores in the semipermeable membrane.
The delivery of hemodialysis is very technical and requires not only specialized equipment but also specially trained and dedicated veterinary specialists.
Conditions Managed by Hemodialysis
Some of the conditions and health concerns that may be successfully managed and treated using hemodialysis include:
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Acute kidney injury
With acute kidney injury or uremia, hemodialysis extends the window of opportunity for renal recovery indefinitely. There is no specific degree of azotemia that warrants dialysis. Most patients presented for hemodialysis for acute kidney injury or failure have been non-responsive to attempted fluid diuresis and pharmacologics.
There is a 50% survival to discharge on average of dogs and cats treated for acute kidney injury or failure with hemodialysis in the absence of underlying chronic disease. The prognosis for recovery from acute kidney injury or uremia depends on etiology, the extent of renal damage, and comorbidities. Survival is variable depending on the cause of the condition.
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Chronic kidney failure
The use of hemodialysis with chronic kidney failure can be effective in providing an excretory boost in veterinary patients, but due to the cost and limited availability, it is less commonly used in chronic cases.
The goal of hemodialysis in chronic kidney failure patients is one of palliation and maintenance of quality of life. Dialysis is used in conjunction with traditional medical therapy. Patients who tend to benefit the most are those who have been diagnosed with stage IV chronic kidney disease free of comorbid conditions.
Prognostic indicators for the benefit of hemodialysis in veterinary patients are unknown and the risks and benefits need to be considered on a case-by-case basis.
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Hyperkalemia
With a decline in glomerular filtration, potassium rapidly accumulates in the body as this is the primary mechanism of excretion. Levels can rapidly reach life-threatening concentrations with an acute drop in GFR. Short-term management can be accomplished pharmacologically to cause transcellular shifts (insulin with dextrose, sodium bicarbonate) or to restore membrane gradients (IV calcium); but, this only results in a transient and modest correction of serum potassium levels since the body’s potassium burden remains unchanged.
Hemodialysis effectively removes potassium from the body decreasing whole body potassium concentrations. The decreased potassium level is almost instantaneous within the cardiac circulation and is cardioprotective within minutes of starting dialysis. The effect is also longer lasting, as hemodialysis can reduce whole-body potassium burdens for 48 hours or more and the process can be repeated indefinitely.
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Oliguria / Anuria
When urine production declines, the patient is at increased risk of overhydration. The only instance where fluid diuresis will increase GRF is if the patient is dehydrated. With intrinsic kidney injury, fluid diuresis does not promote an increase in GFR; it only promotes overhydration, which is strongly associated with an increase in mortality.
Consideration of hemodialysis at the onset of oliguria can prevent this completion and allow for continued parenteral medication and nutrition as needed since fluid balance can be maintained with the removal of free water. Prevention of overhydration with recurrent hemodialysis sessions can prevent overhydration and thus increase the odds of survival.
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Fluid overload
As previously mentioned, fluid overload has been shown to increase the risk of mortality. Estimates from UC Davis are that over 70%-80% of patients presented for hemodialysis are overhydrated. Overhydration in the face of uremia is one of the major negative prognostic indicators for survival in both human and veterinary patients. Hemodialysis can help prevent and treat overhydration with the removal of excess body water.
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Toxins
Toxins or chemicals and medications that are not tightly protein-bound and are small enough to fit through the artificial kidney membrane pores can effectively and quickly be removed with hemodialysis. Additional benefits with hemodialysis are the removal of both parent compounds and metabolites as well as the removal of substances that have already been absorbed from the gut.
Ethylene glycol, which can be found in products such as anti-freeze, paints, and more, is the most common intoxication in cats and dogs. Clinical signs can develop within minutes and can progress to anuric or oliguric renal failure within 12 to 24 hours if left untreated.
Traditional therapy with alcohol or 4-methoperazole should be instituted immediately, however, if hemodialysis therapy is instituted within 5 to 6 hours of ingestion, a single session can not only remove the parent compound but the metabolites as well and is the treatment of choice.
Some other dialyzable toxins or medications that can be removed include:
- Acetaminophen
- Alcohols (ethanol, methanol)
- Aspirin and other salicylates
- Anti-epileptics (Phenobarbital)
- Aminoglycosides
- Baclofen
- Chemotherapeutics
- Lithium
- Mushrooms
- Metformin
- Paraquat
- Theophylline
- Sedative hypnotics