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Nephrology/Urology Program

Elvis, Hemodialysis Patient at Penn VetIn both humans and animals, healthy kidneys clean blood by removing excess fluid, minerals, and wastes. Kidneys also make hormones that keep your bones strong and your blood healthy. When kidneys fail, harmful wastes build up in your animal's body, blood pressure may rise, and you animal's body may retain excess fluid and not make enough red blood cells. When this happens, your animal will need immediate treatment to replace the work of its failed kidneys.

When kidneys are damaged, either through disease or toxins, they must be infused with fluids to try to flush out impurities. In severe cases, hemodialysis is the most common method used to treat advanced and permanent kidney failure.

Focus: Protein Losing Nephropathy

Protein-Losing Nephropathy, or PLN, is a disease affecting certain dogs in which the filtering mechanism of the dog's kidneys is defective and the dog loses protein through urine. Because protein is such an essential nutrient to the body, its loss is a very serious problem. Certain breeds, such as the Soft-Coated Wheaten Terrier, the Bernese Mountain Dog, the Labrador Retriever, and the Golden Retriever. Affected dogs often have adverse reactions to food, including vomiting, diarrhea, or intense itching.

 Dr. JD Foster and his team are conducting a clinical trial on PLN, in which silymarin, a supplement derived from the milk thistle plant, is used in combination with established standard medications.

Learn more about this trial and how to enroll...


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Please pardon our appearance while we improve our lobby to better serve you. We are here for you and your pets, providing the unconditional love and unparalleled expertise you have come to expect from our renowned team.

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About Hemodyalisis

Here are some typical questions our clients ask about hemodialysis:

What can hemodialysis treat?

  • The most common indication for hemodialysis is acute kidney injury.  Patients refractory to medical therapy, as well as oligoanuric patients, are candidates for hemodialysis. Nephrology patient at Ryan Hospital

    Electrolyte disturbances, such as hyperkalemia, can be managed with hemodialysis very quickly and effectively.  

    Chronic kidney disease can also be managed with hemodialysis (typically a four-hour session two or three times a week). Cost, however, can be a limiting factor that prevents most clients from pursuing this option for lifetime management.  

    Hemodialysis is often utilized in cats for stabilization prior to kidney transplantation.  

    Ultrafiltration therapy is a method to remove excessive fluid accumulation in patients with iatrogenic fluid overload (often seen with oligoanuric acute kidney injury) or congestive heart failure.

What is hemoperfusion?

  • Hemoperfusion is performed to help remove certain toxins from blood.  Large toxins or those with strong protein binding are unable to be removed across the filter during hemodialysis; therefore a charcoal cartridge is used to purify the patient’s blood.  This therapy can be quite effective for various intoxications, most commonly NSAIDs.

What other toxicities can be treated with hemodialysis?

  • Ethylene glycol toxicity can be devastating. Animals who become azotemic have a poor to grave prognosis.  Dialysis can be performed to support them while azotemic, but it may take three months or more before renal function returns (if at all). 
  • Canine hemodialysis patient at Penn VetHowever, ethylene glycol is very efficiently dialyzed, and nearly all ethylene glycol can be removed from the patient’s blood within one dialysis treatment. Patients who have been exposed to ethylene glycol, but have not yet become azotemic should be referred for hemodialysis immediately. 
  • Dialysis may remove the toxin in one treatment, thereby preventing renal damage from ever occurring. 
  • The nephrotoxin found within lily plants is unknown; however it is thought to be removed via hemodialysis.  Because of the grave prognosis once a cat has become azotemic after lily intoxication, hemodialysis should be considered in patients who have been exposed, however have not yet become azotemic. 
  • It has not yet been determined if the nephrotoxic component of grapes, raisins, and currants is dialyzable.

How long will my animal require hemodialysis?

  • The duration of dialysis therapy is quite variable.  Many toxins (such as ethylene glycol, lily Ryan Hospital blood donor, Fosseingestion, etc.) can be removed with a single treatment. 
  • Oligoanuric patients with acute kidney injury may only require one to three treatments until they become polyuric, thus often allowing the reintroduction of traditional management. 
  • Patients with severe kidney injury may require weeks to months to regain kidney function.  Dialysis is initially performed on an inpatient basis, then patients are transitioned to outpatient dialysis when stable.

What is the prognosis for patients requiring hemodialysis?

  • The survival for acute kidney injury patients treated with hemodialysis is approximately 50 percent, however there is a wide variability in mortality. 
  • Infectious etiologies (leptospirosis, pyelonephritis) have upwards of 90 percent survival, whereas toxicity (azotemic ethylene glycol or lily) is closer to 10-40 percent. 
  • While 50 percent overall survival may sound poor, remember that nearly 100 percent of these patients have already failed medical therapy.
 

 

In hemodialysis, your animal's blood is allowed to flow, a few ounces at a time, through a special filter Ryan Hospital, Hemodyalisys Equipmentthat removes wastes and extra fluids. The clean blood is then returned to their body. Removing the harmful wastes and extra salt and fluids helps control your animal's blood pressure and keep the proper balance of chemicals like potassium and sodium in its body.

Dialysis is available for both dogs and cats and can be used for acute or chronic kidney failure. Dialysis is used to treat:

  • Acute or chronic kidney failure
  • Animals for whom standard therapy (intravenous fluids, medication, etc.) has proven ineffective
  • Animals with life-threatening complications of kidney failure (e.g. high potassium levels and fluid in the lungs)
  • Animals who have eaten a poison that can be removed with dialysis

When dialysis is used for acute kidney failure, it is continued until the kidneys recover function or it becomes clear that the kidneys are not going to heal.  

Most of the time, whatever kidney repair is going to happen will occur within four weeks.  Occasionally the kidneys will heal sooner, and sometimes they take longer than four weeks to heal.  There is no way to predict recovery time at the outset.

With chronic kidney failure, the kidneys are permanently damaged. Dialysis is continued three times a week for the rest of the patient’s life.  In this case, kidney transplant is the only alternative to chronic dialysis.

Renal transplantation is a treatment option for renal failure in cats. It is important to recognize that renal transplantation is a treatment for renal failure, and not a cure. The goal of renal transplantation is to provide a good quality of life for a cat that would otherwise be unable to survive; however, “normal” life expectancy is not yet achievable by today’s technology.

The Feline Renal Transplantation Program at Penn Vet was successfully initiated in February 1998 by Dr. Lillian R Aronson, VMD, DACVS, Associate Professor of Small Animal Surgery. After she received her VMD and finished an internship at the University of Pennsylvania's School of Veterinary Medicine, Dr. Aronson completed a small animal surgical residency at the University of California, Davis.

Learn more about Renal Transplantation at Penn Vet. 

Consultations and Referrals

Please inquire to learn more about the extracorporeal therapies now being offered at Penn Vet. 

Contacts:

JD Foster, VMD, DACVIM
Director, Hemodialysis and Extracorporeal Therapies
Email: fosterjo@vet.upenn.edu

Referring Veterinarian Office of Ryan Hospital
Vet Phone line: 877-736-6838
email: megann@vet.upenn.edu

We will gladly consult on any cases that you feel will potentially benefit from blood purification. Please call or contact us with any questions.