What is Dialysis and Renal Replacement Therapy?

Dialysis is used to treat kidney failure. There are two types of dialysis: hemodialysis and peritoneal dialysis. When most people talk about dialysis, they are referring to hemodialysis. This involves filtering the dog’s blood through a machine called a hemodialyzer to cleanse it of toxins and waste. This machine contains a solution called dialysate, which is separated from the blood through a dialyzer membrane. Dialysate attracts toxins and waste from the blood through the membrane. Because the IV is long and large, an IV port may be left in place under the skin until the treatments are completed. A single hemodialysis treatment lasts between three to five hours. Peritoneal dialysis essentially uses the dog’s abdomen as the dialyzer membrane. Dialysate is administered to the abdomen and absorbs toxins and waste for several hours. The waste material is then drained.

Continual renal replacement therapy (CRRT) is similar to dialysis, but takes longer. Toxins are removed at a continuous rate between 24 to 48 hours. This procedure is meant to filter the blood of toxins just as the kidney would. With CRRT, fewer treatment sessions are required. It is less commonly performed than dialysis, is more invasive, and will require sedation or anesthetization as well as hospitalization. However, it is also associated with fewer complications.

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Dialysis and Renal Replacement Therapy Procedure in Dogs

Hemodialysis

  1. A thorough physical examination is carried out at the start of each session.
  2. Dogs will lie on a soft pad and wear a special harness for the duration of the session. This is meant to comfortably restrain the dog while still allowing him to move.
  3. The dialysis catheter is unwrapped and cleaned prior to insertion.
  4. Blood samples are taken and analyzed before treatment begins.
  5. The lines hooked to the dialysis machine are attached to the catheter lines.
  6. The dialyzer extracts blood while simultaneously replacing it with specialized fluids to keep the dog stable during the procedure.
  7. Up to one cup of blood is cleaned at a time before it returns to the body, and new blood is drawn into the machine. This cycle continues for several hours until the treatment is complete.
  8. Dogs are allowed to eat and drink during the procedure.
  9. Once the dog is stable, he is released from the treatment center.

CRRT

  1. Steps 1-4 are repeated.
  2. The dog will be sedated or anesthetized.
  3. The catheter is connected to a special machine, which will filter the blood over a 24 to 48 hour period.
  4. Sedation or anesthetization is typically required for the full duration of treatment.

Efficacy of Dialysis and Renal Replacement Therapy in Dogs

The efficacy of dialysis and CRRT will depend on the overall health of the dog and the nature of the disease. Improvement is typically seen within four weeks. However, healing times will vary based on the individual case. Some dogs, particularly those with chronic kidney failure, may need to remain on dialysis for the rest of their lives.

Dialysis and Renal Replacement Therapy Recovery in Dogs

Most dogs will be lethargic on the return home, and will spend the day sleeping. Postprocedural pain is not usually a problem. Dietary changes are often recommended in conjunction with treatment. Some dogs will require intravenous fluid supplementation at home. For these cases, a veterinary dialysis specialist will train you. Stressful situations should be avoided, and the dog should be kept calm as much as possible. Follow-up appointments will be scheduled to administer additional treatments, monitor healing, and conduct additional tests.

Cost of Dialysis and Renal Replacement Therapy in Dogs

The cost of dialysis and CRRT will vary based on the number of treatments needed as well as standards of living and additional costs incurred. The average price of dialysis and CRRT, for the first two to three treatments, ranges from $3,000 to $4,500. Subsequent treatments typically cost $600 to $700 each. This price may not include the cost of hospitalization.

Dog Dialysis and Renal Replacement Therapy Considerations

Complications from dialysis may include, but are not limited to:

  • Nausea
  • Loss of appetite
  • Metabolic bone disease
  • Carnitine and taurine deficiency
  • Complications and infection associated with dialysis catheter placement

Dogs undergoing dialysis for chronic kidney failure will require treatment for the rest of their lives. The only alternative treatment for chronic kidney failure is kidney transplant.

These complications are not associated with CRRT. The primary complication with CRRT is blood clotting in the CRRT circuit. The dialysis specialist will discuss all potential complications with you prior to treatment.

Dialysis and Renal Replacement Therapy Prevention in Dogs

Kidney disease and kidney failure are difficult to prevent because the cause often remains unidentified. Dietary changes may help prevent kidney disease. Poisons and toxic substances should be kept out of reach of pets at all times to prevent ingestion. Dogs treated for kidney failure, particularly chronic kidney failure, should not be bred.

Dialysis and Renal Replacement Therapy Questions and Advice from Veterinary Professionals

Libby
Shih Tzu
14 Years
Serious condition
1 found helpful
Serious condition

Has Symptoms

High blood pressure
Doesn't want to eat
not feeling well
nauseous
elevated kidney values

Medication Used

0.9% sodium chloride fluid 100ml/day via needle

I have been maintaining my dog with a creatine level at 2 for several years with under skin hydration and diet. Last week she had abdominal surgery to remove a mass near her intestine. This mass was benign but was causing blockage of food intake so the surgery was required. However a CT scan prior to surgery used anesthesia and contrast and surgery later the same day also obviously used anesthesia.
These toxins raised her creatine value to 6. She is now receiving IV fluids for 2 days which brought the value to 5.2 but its increasing blood pressure and causing a slight heart murmur. Rather than introduce new problems, I would like to find a facility in the South Florida area that can do either dialysis or continual renal replacement therapy (CRRT). However locating a facility online with this capability has been confusing with lots of inaccurate information. Can you please provide me with facilities that are can do this in my area and are best equipped to concentrate on renal failure? Thank you in advance, Craig

Dr. Callum Turner, DVM
1488 Recommendations
As far as I am aware, the nearest facility to you that would have the ability to perform dialysis or continuous renal replacement therapy would be the Veterinary School in Gainesville which is probably further north than you were wishing. Whilst Libby may have high creatine, her case may still not be suitable for dialysis or continuous renal replacement therapy and you would need to share Libby’s case notes with them for review prior to a visit; it has been only two days, her creatine may reduce further with more fluid therapy. Regards Dr Callum Turner DVM http://smallanimal.vethospital.ufl.edu/clinical-services/internal-medicine/hemodialysis/

Libby was hospitalized from 8/30 to 9/3. There are two issues she's currently facing -

(1) An acute renal failure event occurred from a combination of anesthesia plus contrast for a CT scan and anesthesia again the same day on 8/25 for surgical removal of mass from her GI tract. As noted previously, her creatinine standard is 2.0 due to her chronic kidney issue and she's been maintained there for years. After not eating for 6 days after surgery I brought her to hospital where her creatinine was discovered at 6.0. Day 1 they got it to 5.8, day 2 to 4.8, day 3 to 4.3, day 4 to 4.4. At 4.4 I decided to take her home to eliminate the stress of strangers at the hospital poking at her day and night with no familiarity. Home she's with all the smells she knows and people she loves and her sister dog.
(2) She hasn't been interested in eating since surgery but tolerating easy food via feeding tube, the gradual introduction to kidney friendly foods is also a mission.

At home she's receiving Lactated Ringer's fluid 100ml via needle under skin daily. This differs from her previous maintenance of 0.9 sodium chloride 100ml via needle under skin 3 times a week. If anyone has info on these fluids with regard to renal failure, please let me know.

She's also on a blood pressure med called Anlodipine 1.25mg 2x/day since all the IV fluids increase her blood volume.

She's on a GI stimulant/nausea med called Metoclopramide 5mg 3x/day (30 mins before feeding) to hopefully encourage her digestive system to do its job.

She's also on an antibiotic med called Clavamox 62.5mg 2x/day (with feeding). I don't know why this was prescribed and I should not she was given a antibiotic shot after surgery which apparently lasts 14 days. Hoping there is no conflict here. I'm also hoping all these meds are kidney friendly.

For her feeding diet she gets Clinicare every 4-6 hours to consume a can/day. Tomorrow she will be transitioning to Royal Canine gastrointestinal high energy canned food. This will be blended to feed via feeding tube until she hopefully takes interest in eating herself again.

At home she sleeps a lot but still opens her eyes wide to show that spark in her eye to make it through. Outside she'll walk down driveway to grass to pee and then wants to go back inside. She only made on giant stool several days ago.

If anyone has any similar experience with acute renal failure and most effective techniques to help clear toxins and keeping it very easy on the kidney, please let me know. Also if you have any experience with any of the meds/ treatment or have other ideas or supplements to consider, please post a reply.

Also I would like to note the biopsy of the mass came back and it was not cancerous. It was an adenomatous polyps.

Thank you all for your time and interest in Libby's current situation.

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Bailey
Maltipoo
7.3
Moderate condition
0 found helpful
Moderate condition

Has Symptoms

lack of appetite

My dog (maltipoo 11lb, 7.3 yers) has CKF, diagnosed since October. Can I ask questions regarding her diet and treatment here. Just to have another opinion? Doing 150cc of hydration every day. Meds listed below.

Dr. Callum Turner, DVM
1488 Recommendations

Chronic kidney failure can be a difficult condition to manage and may need to be continually adjusted to keep a patient's biochemistry values within an acceptable range. One of the most important aspects of management is nutrition, before you start to Google receipes there are many commercial diets available which contain low amounts of high quality protein and are nutritionally balanced for dogs with kidney failure; high quality protein include meat and egg as opposed to protein from plant sources. Another important part of management is fluid therapy, keeping a dog hydrated; increasing blood volume reduces the relative concentration of any waste products circulating in the blood. I’ve added a few links below which should answer many questions which you may have. Regards Dr Callum Turner DVM
www.vetmed.wsu.edu/outreach/Pet-Health-Topics/categories/diseases/chronic-kidney-disease-and-failure
www.vetmed.ucdavis.edu/vmth/small_animal/nutrition/client_info_sheets/chronic_renal_disease.cfm
www.msdvetmanual.com/urinary-system/noninfectious-diseases-of-the-urinary-system-in-small-animals/renal-dysfunction-in-small-animals

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