Dialysis & Extracorporeal Therapies

Dialysis allows us to keep the patient alive and feeling well in the days, weeks or months that the kidneys may need to heal.

Extracorporeal therapy involves drawing blood from a patient, processing it in some way and then returning it to the patient. Haemodialysis is one form of extracorporeal therapy where a dialysis machine is able to extract small unwanted molecules from a patient’s blood, such as those that accumulate in renal failure.

Haemodialysis in animals is very different to humans. Most humans on dialysis are chronic kidney disease patients waiting for a renal transplant. In veterinary medicine, the primary population receiving dialysis are dogs and cats with acute kidney injury, where their disease is potentially reversible but may take weeks to months.

Dialysis allows us to keep the patient alive and feeling well in the days, weeks or months that the kidneys may need to heal.

Dogs and cats going onto haemodialysis are usually the group with such bad disease that euthanasia is the only other option, but dialysis can achieve approximately 50% survival in these patients. Of these survivors, 50% can achieve normal kidney function back (measured by biochemical means). The goal is to get them back to how they were before the acute kidney injury. 

There are very few veterinary patients that are appropriate chronic dialysis candidates (due to ethics of surrounding their own quality of life and blood donors).

Extracorporeal therapies also include plasma exchange, where plasma is removed from a patient and replaced with donor placement. This is used commonly in immune mediated diseases such as IMHA, IgG can be removed by plasma exchange. Dogs with resistant disease and the worst prognostic indicators can still achieve similar or better success compared to average IMHA patients on medical management.

Different extracorporeal therapies can also be used to remove toxins, the most common being NSAID overdoses and ethylene glycol. Future applications in oncology, systemic shock/SIRS patients.

The most invasive part of the procedure is a sedation to place a jugular catheter, or an anaesthesia to place a feeding tube because the patient is ill from their disease. Patents are conscious during this treatment, receive pats, attention and food. Are able to move around on a padded bed. They are generally not sedated for the procedure.

The most important part of any extracorporeal therapy unit or dialysis unit is the training and experience of the nurses and clinicians. The machines are built for humans so inexperienced use can lead to catastrophic consequences in patients, or reduction in chance of good outcome. These patients are tricky to manage between treatments and may initially be critical – it is important to have support services (critical care, blood bank, anaesthetists, radiologists).



The later we start these treatments, the less chance of a successful outcome, or the higher difficulty and expense managing them. Early referral also reduces risk of toxicity induced organ damage and often reduces cost to client if the patient is in a more stable state.

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