Information for Veterinarians

Hemodialysis Information for Veterinarians

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Hemodialysis enables the removal of metabolic solute and fluid waste from the bloodstream of an animal or human by allowing those wastes to diffuse out of the blood across many semi-permeable, biocompatible membranes. The dialysis machine pumps blood from the patient through a dialyzer (artificial kidney) outside the body and then pumps the purified blood back to the patient; these processes happen simultaneously and continuously throughout a (usually) 3-6 hour treatment session.

A dialysis candidate may be any patient with acute uremia or oligoanuria unresponsive to medical management. In addition to treating severe azotemia, dialysis can correct severe hyperkalemia, acidemia and volume overload during the course of a treatment. Usually, three treatments given on consecutive days are required: to safely treat a severely azotemic animal; to avoid sudden, extreme osmotic shifts; and to permit the brain to adapt to osmotic changes. Common reasons for dialysis referral in veterinary medicine include ethylene glycol ingestion, leptospirosis (dogs), ureteral obstruction (cats), pyelonephritis, conditioning for transplantation, acute renal failure from systemic disease (e.g., pancreatitis), and acute uremia of unknown cause. We especially encourage referral of acute (within 12 hours of ingestion) ethylene glycol ingestion. In many of these patients, dialysis can quickly and thoroughly remove ethylene glycol and its nephrotoxic metabolites from the bloodstream before renal damage occurs, at a comparable cost to hospitalization and 4-MP therapy.

Dialysis is an outstanding intervention in many acute poisonings. Some drugs such as aspirin, acetaminophen and many prescription medications will diffuse through the dialyzer membrane and thus can be removed directly from the bloodstream. We can also remove many non-dialyzable substances via an adsorption process called hemoperfusion. For hemoperfusion techniques, a canister of adsorbent charcoal or polystyrene beads is added in circuit with the dialyzer.

Please call us early in the course of patient management. We encourage consultation as soon as you suspect a patient might benefit from extracorporeal therapy; delay in instituting therapy for a pet with acute renal failure can jeopardize a successful outcome. We’re always happy to discuss cases, whether or not they are eventually referred.

Spare the jugulars! Successful dialysis treatment requires high blood flow rates (5-50 ml/minute for a cat, 25-350 ml/minute for a dog), which necessitates placement of a very large-gauge jugular catheter. We, therefore, ask that you avoid jugular venipuncture and jugular catheters whenever possible in a potential referral to help ensure a routine, percutaneous catheter placement avoiding a more complicated, surgical placement with general anesthesia.

We feel strongly about talking to clients personally before they arrive for a dialysis appointment. Hemodialysis is intensive and can be quite expensive. We want to ensure that clients understand the financial and emotional commitment involved with dialysis, as well as the potential benefits and limitations of therapy for a particular pet’s illness.

Please complete and fax a referral summary form prior to patient arrival, if at all possible! This helps tremendously with efficiency and client service. If you need summary forms, we’ll be glad to send them to you.

Referral Form Information

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Referral Form (PDF)

To facilitate this referral for your clients and for us, please fill out and fax (858-875-7584) Referral Form along with recent pertinent clinical information, laboratory data, ultrasound reports, etc. Entire medical records are NOT necessary or helpful, but a complete, concise clinical summary IS. If we have not spoken directly with clients regarding an emergency case, be sure they have accurate expectations. UCVMC-SD clinicians receive cases requiring immediate dialytic therapy directly, whether during normal hours or after hours/on weekends. After-hours cases not requiring immediate dialysis may be received by an emergency doctor at the Veterinary Specialty Hospital (with whom we work closely) who will communicate directly with us on the patient’s arrival/assessment, and will transfer the patient the following morning for further care.

Be sure clients have accurate financial estimates.

Renal consultation only: costs will vary from $130 (consultation only) to $1500 (if lab tests, imaging, feeding tube placement, medications, transfusion, etc. are required.

Patients requiring dialysis: Our standard dialysis estimate is $3500-$4000 for the first 2-3 treatments and $600-$700 per treatment thereafter. (This includes lab tests, dialysis catheter placement, feeding tube placement, anesthesia, oxygen, and transfusion if necessary), not including hospitalization at the Veterinary Specialty Hospital. The first three treatments will span 3-5 days. Depending on the caliber and intensity of care required by a given patient, hospitalization costs will range from $300-$1200/day. Detailed estimates are provided once a patient is assessed. Clients whose patients will be receiving dialysis will be required to leave a deposit of between $2000-$3000 before treatment and will also be required to leave a deposit at Veterinary Specialty Hospital. Many initially critical dialysis patients will be able to become dialysis outpatients after several days of therapy. This substantially decreases associated costs, since hospitalization charges are eliminated, and significantly improves patient quality of life.