Peritoneal dialysis in dogs and cats: 27 cases (1976-1987)

The records of 25 dogs and 2 cats treated with peritoneal dialysis during an 11-year period were evaluated. The indications for peritoneal dialysis were acute renal failure in 21 animals, chronic renal failure in 5 animals, and azotemia of undetermined cause in 1 animal. Peritoneal dialysis resulted in a significant (P less than 0.05) decrease in serum urea nitrogen concentration in 19 of the dogs and a significant (P less than 0.05) decrease in serum creatinine in 20 dogs. The most common complication of peritoneal dialysis was hypoalbuminemia (11 animals affected). Other common complications were dialysate retention/catheter obstruction (8 animals), peritonitis (6 animals), hypochloremia (6 animals), and subcutaneous leakage of dialysate (6 animals). Twelve dogs and 2 cats died during treatment, 6 dogs were euthanatized, and 1 dog was lost to follow-up evaluation. The remaining 6 dogs survived and were discharged from the hospital after successful peritoneal dialysis. On the basis of the results of this study, the authors concluded that peritoneal dialysis, although associated with a high complication rate, was a successful technique for reducing azotemia in dogs with acute and chronic renal failure. Survival rates were poor because of the severity of the underlying renal diseases.     

Intermittent peritoneal dialysis for the treatment of acute renal failure in two horses

Acute renal failure (ARF) in the horse is most commonly due to decreased renal perfusion or a nephrotoxic insult. Conventional therapy includes the administration of i.v. fluids, frusemide, mannitol and/or dopamine, as well as general supportive care. However, not all horses with ARF will respond to these treatments. In these cases, peritoneal dialysis is a viable therapeutic option. This case report describes 2 horses with ARF that was refractory to conventional therapy. Intermittent peritoneal dialysis was used effectively in both cases for treatment of the ARF. Dialysis was easy to perform and associated only with minor complications. To the authors' knowledge, this is the first report describing the successful use of intermittent peritoneal dialysis in the treatment of ARF in the horse.     

Pleural dialysis in the management of acute renal failure in two dogs

Pleural dialysis, as an alternative to peritoneal dialysis and hemodialysis, was shown in a limited number of cases to be an inexpensive and easily applied technique for use in dogs. It is a viable modality for the management of acute renal failure in dogs that have suffered an acute but reversible renal insult, in which volume replacement and dopamine/furosemide infusion fails to reverse the oliguric state.     

Use of continuous-flow peritoneal dialysis for the treatment of acute renal failure in an adult horse

A 15-year-old Paso Fino gelding was evaluated because of acute renal failure following an episode of exertional rhabdomyolysis. The horse was azotemic and treated conservatively at another referral practice with no improvement in the azotemia. With conservative treatment and intermittent peritoneal dialysis, the horse had minimal improvement. Continuous-flow peritoneal dialysis (CFPD) was instituted on day 7 and continued for 3 consecutive days. Dramatic changes in the horse's attitude and serum creatinine concentration were detected within the first 24 hours of CFPD treatment. The horse remained hospitalized for 23 days; within 3 months of discharge, serum BUN and creatinine concentrations had returned to within the reference ranges and the horse had resumed normal activity. In adult horses, it appears that CFPD can be used to successfully treat acute renal failure that is refractory to conventional treatments.     

Peritoneal dialysis in dogs and cats

The peritoneal dialysis was carried out in dogs for the fist time in 1946. Since then, this method of therapy has been applied more and more frequently in veterinary medicine. The dialysis therapy is mainly recommended in the acute renal failure. Accordingly to the time period over which dialysis is performed and the flow pattern of the dialysate, different types of the peritoneal dialysis are distinguished. In carnivores, intermittent peritoneal dialysis is the most commonly applied method of dialysotherapy. However, despite a considerable effectiveness of this method, complications including uncontrolled transportation of elements and proteins or problems with catheter occur quite often. This article describes indications and contraindications which enable to qualify animal patients for dialysotherapy, and detailed principles of peritoneal dialysis procedure.     

Reversal of ethylene glycol-induced nephrotoxicosis in a dog

Ethylene glycol-induced nephrotoxicosis was diagnosed in a dog with acute renal failure. Histologically, the dog had proximal tubular degeneration and necrosis, intraluminal calcium oxalate crystals, generally intact tubular basement membranes, and evidence of tubular regeneration. After 20 days of peritoneal dialysis and diuresis, renal function was adequate to maintain homeostasis without supportive care. Nine weeks after onset of the ethylene glycol-induced renal failure, the dog's kidneys were histologically and functionally normal.     

Evaluation of peritoneal fluid lactate as a marker of intestinal ischaemia in equine colic

REASONS FOR PERFORMING STUDY: The most common cause of death as a direct result of colic is acute circulatory failure secondary to intestinal ischaemia. Early and accurate recognition of ischaemic bowel is essential to decrease complications and increase survival. Blood to peritoneal lactate values have been evaluated as a prognostic indicator, but lactate values characterised by type of lesion have not been reported. HYPOTHESIS: Plasma and peritoneal lactate values are higher in horses with intestinal ischaemia secondary to a strangulating obstruction (ISSO). METHODS: Venous blood and peritoneal fluid were collected sequentially from 20 clinically healthy horses and 189 horses admitted for colic during a one-year period. Blood gas, pH, electrolyte (K+, Na+, Ca++, Cl-), glucose and lactate values were determined for blood and peritoneal fluid samples; other values recorded for peritoneal fluid included gross appearance, total protein and nucleated cell count. Information regarding diagnosis, treatment and outcome was retrieved from the medical records. RESULTS: Peritoneal and plasma levels of lactate were lower in control compared to clinical cases. Horses with ISSO had a higher peritoneal lactate value (8.45 mmol/l) than those with nonstrangulating obstruction (2.09 mmo/l). Factors with the strongest correlations with the presence of ISSO were changes in the gross appearance of the peritoneal fluid and values of peritoneal fluid chloride, pH and log10 lactate. CONCLUSIONS: Analysis of peritoneal fluid gross appearance, pH, lactate and chloride can be used for diagnosis of ISSO. POTENTIAL RELEVANCE: Peritoneal fluid lactate is a better predictor of ISSO than blood lactate and may aid in early detection of catastrophic peritoneal lesions such as intestinal strangulation and rupture.     

Management of acute renal failure in cats using peritoneal dialysis: a retrospective study of six cases (2003-2007)

Information regarding the use and success of peritoneal dialysis (PD) in the management of acute renal failure (ARF) in cats is lacking. The purpose of this retrospective study is to describe the indications, efficacy, complications and outcome of cats undergoing PD for ARF. Six cats that underwent PD for treatment of ARF of various etiologies were included. PD effectively replaced renal function in all cats and allowed renal recovery in 5/6 cats. Five cats were discharged and one cat died. Complications were reported in all cats and included subcutaneous edema (n=5), hyperglycemia (n=4), dialysate retention (n=3), and hypoalbuminemia (n=3). A novel technique consisting of a Blake surgical drain and an intermittent closed suction system was used, which appears to be a viable option for PD in cats. Although complications are common, PD is an effective renal replacement therapy for ARF in cats and carries a reasonable prognosis in selected cases.     

Lily toxicity in the cat

Lilies are commonly kept flowering ornamental plants that are used in holiday celebrations, weddings, and funerals, and in various floral arrangements. Lilies of genera Lilium and Hemerocallis (day lilies) have been shown to cause nephrotoxicity in cats. Confusion arises because so many different plants are called lilies. Members of the genus Convallaria (lily of the valley), while sparing on the kidneys, elicit toxic effects because they possess potent cardiac glycosides similar to digitalis. Even more confusing as to which lilies are toxic is the fact that many hybrids exist. The majority of the public do not know that lilies can be dangerous to cats and, in fact, cannot correctly identify the plants in their own homes. Cats have been shown to be extremely sensitive to the toxic effects of lilies. As little as 2 leaves or part of a single flower have resulted in deaths. It should be pointed out that the whole plant-petals, stamen, leaves, and pollen are toxic. The exact toxic dose and the precise toxins responsible for renal damage are currently unknown. The quick onset of clinical signs suggests a rapid absorption rate of the toxin. The renal tubular epithelium appears to be the target of the toxin. Studies indicate that it is the water-soluble fraction of the lily that is nephrotoxic. In cats, clinical signs of lily intoxication include salivation, vomiting, anorexia, and depression. Polyuric renal failure leads to dehydration and anuric renal failure and death results. No analytic verification of lily ingestion is currently available. Successful treatment includes initiation of fluid diuresis before the onset of anuric renal failure. Once anuria develops, peritoneal dialysis or hemodialysis is the only potential treatment. Differential diagnoses of lily poisoning include any potential cause of acute renal failure in a cat. Prognosis is excellent if fluid diuresis is started before anuric renal failure has developed. The public must be made aware of potentially toxic ornamental house plants.     

Peritoneal d-Dimer Concentration for Assessing Peritoneal Fibrinolytic Activity in Horses with Colic

Background: Plasma d -dimer concentration is a useful marker to assess systemic coagulation and fibrinolytic activities in humans, dogs, and horses. Peritoneal fibrinolytic activity increases in horses with colic, especially in horses with endotoxin in the peritoneal fluid.
Hypothesis/Objectives: Peritoneal d -dimer concentration can be used to assess peritoneal fibrinolytic activity in horses with severe gastrointestinal (GI) disorders and altered peritoneal fluid.
Animals: Two hundred and twenty-one colic horses and 15 control horses.
Methods: Prospective observational clinical study. Blood and peritoneal fluid were collected on admission. Horses were grouped according to diagnosis, peritoneal fluid analysis, and outcome. Peritoneal d -dimer concentration was determined, together with peritoneal tissue-plasminogen activator (t-PA) and plasminogen activator inhibitor (PAI-1) activities. Plasma d -dimer concentration also was measured.
Results: Peritoneal d -dimer concentration was significantly higher in all colic groups compared with controls, and in horses with enteritis, peritonitis, and ischemic disorders compared with horses with large intestinal obstructions. Peritoneal d -dimer concentration was significantly higher in horses with altered peritoneal fluid (modified transudate and exudate) compared with horses with normal peritoneal fluid analysis. Plasma d -dimer concentration also was significantly higher in the peritonitis group, and in horses with altered peritoneal fluid analysis. Peritoneal and plasma d -dimer concentrations also were significantly higher in nonsurvivors. Peritoneal d -dimer concentration was significantly correlated with decreased peritoneal t-PA activity and increased peritoneal PAI-1 activity.
Conclusions and Clinical Importance: Peritoneal d -dimer concentration is markedly higher in severe GI disorders, and it can be used to assess peritoneal fibrinolytic activity in horses with colic.     

Hemodialysis

Hemodialysis is a therapeutic procedure that uses the extracorporeal circulation of a patient's blood to ameliorate the azotemia, fluid, electrolyte, and acid-base abnormalities characteristic of the uremic syndrome. Hemodialysis is principally used for the management of acute and chronic renal failure that is refractory to conventional medical therapy. Additional applications include acute intoxications (e.g., ethylene glycol poisoning) and preoperative conditioning of renal transplant recipients. Hemodialysis is a technically demanding procedure that requires an extensive array of sophisticated delivery equipment and specifically trained and dedicated staff to perform, monitor, and ensure the integrity and safety of the procedure in critically ill patients. The advent of neonatal dialysis delivery equipment has ensured that hemodialysis is a feasible, efficacious, safe, and indispensable therapy for dogs and cats with life-threatening renal failure. Increased awareness and acceptance of hemodialysis as an effective renal replacement therapy coupled with increased owner demand guarantee a bright future for hemodialysis as a viable therapeutic modality.     

Veterinary hemodialysis: advances in management and technology.

Hemodialysis (HD) is a renal replacement therapy that can enable recovery of patients in acute kidney failure and prolong survival for patients with end-stage kidney failure. HD is also uniquely suited for management of refractory volume overload and removal of certain toxins from the bloodstream. Over the last decade, veterinary experience with HD has deepened and refined and its geographic availability has increased. As awareness of the usefulness and availability of dialytic therapy increases among veterinarians and pet owners and the number of veterinary dialysis facilities increases, dialytic management will become the standard of advanced care for animals with severe intractable uremia.     

Peritoneal effusion in cats: 65 cases (1981-1997)

OBJECTIVE: To determine signalment, diagnoses, presence of effusions in multiple sites, and outcome in cats with peritoneal effusion. DESIGN: Retrospective case series. ANIMALS: 65 cats. PROCEDURE: Medical records from 1981 to 1997 were reviewed to obtain information on cats with peritoneal effusion identified on physical examination, radiographs, abdominal ultrasonograms, or at necropsy. RESULTS: Conditions most commonly associated with peritoneal effusion in cats, in order of frequency, were cardiovascular disease, neoplasia, hepatic disease, renal disease, feline infectious peritonitis, peritonitis attributable to other causes, and urinary tract trauma. Dilated cardiomyopathy (DCM) was the most common disease associated with peritoneal effusion; however, DCM was diagnosed in most of these cats before taurine deficiency was found to be a primary cause of this form of cardiomyopathy in cats. Neoplasia was the most common cause after 1987. Right-sided congestive heart failure was the most commonly associated disorder in cats < 1 year old, whereas neoplastic disease was more common with increasing age. Most effusions were detected during the initial physical examination and were modified transudates. Peritoneal effusion was commonly accompanied by fluid accumulation elsewhere, particularly pleural effusion. The prognosis for a cat with abdominal effusion in this study was poor (mean survival time, 21 days; range, 1 to 350 days; median, 2.5 days). CLINICAL IMPLICATIONS: The primary differential diagnosis for peritoneal effusion in cats is neoplastic disease in older cats and right-sided heart failure in kittens. Diseases associated with peritoneal effusion generally have poor prognoses.     

Urinary alkaline phosphatase and 7-glutamyl transferase as indicators of acute renal damage in dogs

Urinary alkaline phosphatase (AP) and 7-glutamyl transferase (GGT) levels were measured in normal dogs, dogs with chronic renal failure, and dogs with acute renal failure, as confirmed by renal histology. The median values for urinary AP were 5–8 iu/litre/mmol creatinine for normal dogs, 6–7 for dogs with chronic renal failure and 49-4 for dogs with acute renal failure. The median values for urinary GGT were 3–4 iu/litre/mmol creatinine for normal dogs, 4–9 for dogs with chronic renal failure and 9-6 for dogs with acute renal failure. The results suggest that urinary AP can be used as an indicator of acute renal damage in the dog. GGT was shown to be less useful. No clear correlations were found between urinary enzyme levels and the extent of morphological kidney damage.     

Collection and analysis of peritoneal fluid from healthy llamas and alpacas

OBJECTIVE: To describe a technique for abdominocentesis in camelids and report peritoneal fluid biochemical and cytologic findings from healthy llamas and alpacas. DESIGN: Prospective study. Animals-17 adult llamas and 5 adult alpacas. PROCEDURES: Right paracostal abdominocentesis was performed. Peritoneal fluid was collected by gravity flow into tubes containing potassium-EDTA for cell count and cytologic evaluation and lithium heparin for biochemical analysis. Blood samples were collected via jugular venipuncture into heparinized tubes at the same time. Cytologic components were quantified. Fluid pH and concentrations of total carbon dioxide, sodium, potassium, chloride, lactate, and glucose were compared between peritoneal fluid and venous blood. RESULTS: All but 3 camelids had peritoneal fluid cell counts of < 3,000 nucleated cells/microL, with < 2,000 neutrophils/microL and < 1,040 large mononuclear cells/microL. All but 1 had peritoneal fluid protein concentrations of > or = 2.5 g/dL. Peritoneal fluid of camelids generally contained slightly less glucose, lactate, and sodium and roughly equal concentrations of potassium and chloride as venous blood. CONCLUSIONS AND CLINICAL RELEVANCE: Peritoneal fluid was collected safely from healthy camelids. Compared with blood, peritoneal fluid usually had a low cell count and protein concentration, but some individuals had higher values. Electrolyte concentrations resembled those found in blood. High cell counts and protein concentrations found in peritoneal fluid of some healthy camelids may overlap with values found in diseased camelids, complicating interpretation of peritoneal fluid values.     

Evaluation of peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity for detection of septic peritonitis in horses

OBJECTIVE: To determine whether peritoneal fluid pH, glucose concentration, and lactate dehydrogenase activity can be used to differentiate horses with septic peritonitis from those with nonseptic peritonitis. DESIGN: Prospective study. ANIMALS: 46 horses, including 10 healthy horses, 15 horses with septic peritonitis, and 21 horses with nonseptic peritonitis. PROCEDURE: Peritoneal fluid and blood samples were analyzed for pH, glucose concentration, and lactate dehydrogenase activity. Complete blood cell counts were performed, and peritoneal fluid samples were submitted for bacterial culture. RESULTS: Horses with septic peritonitis had significantly lower peritoneal fluid pH and glucose concentrations than horses with nonseptic peritonitis and healthy horses. Compared with other tests, serum-to-peritoneal fluid glucose concentration differences > 50 mg/dl had the highest diagnostic use for detection of septic peritonitis. Peritoneal fluid pH < 7.3, glucose concentration < 30 mg/dl, and fibrinogen concentration > 200 mg/dl were also highly indicative of septic peritonitis. CLINICAL IMPLICATIONS: Peritoneal fluid pH and glucose concentration can be used to assist in the identification of horses with septic peritonitis. These measurements can provide an early indication of sepsis, especially if cytologic evaluation of peritoneal fluid is unavailable or results are equivocal and peritoneal fluid bacterial culture results are pending.     

Peritoneal fluid analysis in the diagnosis of abdominal disorders in cattle: a retrospective study

A retrospective study of bovine peritoneal fluids collected over a two year period was conducted. Of a total of 66 cattle studied, 31 had a nonseptic peritonitis, 11 acute bacterial peritonitis, eight ascites and 16 miscellaneous disorders such as abomasal impaction, enteritis and lymphosarcoma. Peritoneal fluid analysis was a useful aid in the diagnosis of abdominal disorders of cattle, especially as hematological changes were absent in many cases. Due to relatively low nucleated cell counts in bovine peritonitis, all parameters (i.e. nucleated cell count, total protein and differential cell counts) must be evaluated before interpretation. A nucleated cell count of greater than 6000 cells/μL and total protein content of greater than 3 g/dL was consistent with the diagnosis of peritoneal inflammation in 80% of the cases studied. An atlas of cell types common to bovine peritoneal fluid is presented.