Mod 1: Introduction to Hemodialysis in Veterinary Medicine
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Questions and Answers

What is one of the advantages of continuous renal replacement therapy (CRRT) compared to intermittent therapies?

  • Slower ultrafiltration rates for hemodynamic stability (correct)
  • More nurse workload
  • Increased anti-coagulant exposure
  • Higher costs

    • Prolonged intermittent daily renal replacement therapy (PIRRT) is a type of continuous renal replacement therapy.

    False

    What does AKI stand for?

    Acute Kidney Injury

    The __________ membrane is used during peritoneal dialysis.

    <p>peritoneal</p> Signup and view all the answers

    Match the renal replacement therapy modalities to their characteristics:

    <p>IHD = Intermittent Hemodialysis CRRT = Continuous Renal Replacement Therapy PD = Peritoneal Dialysis PIRRT = Prolonged Intermittent Daily Renal Replacement Therapy</p> Signup and view all the answers

    Which of the following factors dictate the choice of dialysis modality?

    <p>Degree of azotemia</p> Signup and view all the answers

    Sustained low-efficiency dialysis (SLED) is a type of intermittent therapy.

    <p>True</p> Signup and view all the answers

    What does the term 'anti-coagulant exposure' refer to in dialysis?

    <p>The use of anticoagulants to prevent blood clotting during dialysis.</p> Signup and view all the answers

    Which of the following are indications for renal replacement therapy? (Select all that apply)

    <p>Severe electrolyte imbalances</p> Signup and view all the answers

    Peritoneal dialysis requires specific medical equipment for its procedure.

    <p>False</p> Signup and view all the answers

    What is the total score obtained in the Duke Segev scoring model mentioned in the content?

    <p>17.2</p> Signup and view all the answers

    The primary difference between hemodialysis and peritoneal dialysis is that hemodialysis typically requires a dedicated __________.

    <p>central venous catheter</p> Signup and view all the answers

    Match the renal replacement therapy modality with its key characteristic:

    <p>Peritoneal Dialysis = Low-efficiency treatment Intermittent Hemodialysis = High efficiency treatment Continuous Renal Replacement Therapy = Variable work-intensity Hybrid Forms = Different duration techniques</p> Signup and view all the answers

    Which of the following is true regarding complications of dialysis?

    <p>They can include infections associated with catheter use</p> Signup and view all the answers

    Anticoagulation is not necessary for all types of renal replacement therapy.

    <p>True</p> Signup and view all the answers

    What is the common term used for prolonged intermittent renal replacement therapy?

    <p>PIRRT</p> Signup and view all the answers

    Which molecule is most likely removed mainly by diffusion in hemodialysis?

    <p>Urea (60 Da)</p> Signup and view all the answers

    Hemofiltration (HF) uses diffusion as its primary mechanism for solute removal.

    <p>False</p> Signup and view all the answers

    What is the primary purpose of renal replacement therapy (RRT)?

    <p>To replace the natural function of the kidneys in filtering the blood.</p> Signup and view all the answers

    Continuous venovenous hemofiltration (CVVHF) is primarily based on ______.

    <p>convection</p> Signup and view all the answers

    Match the type of renal replacement therapy with its characteristics:

    <p>Hemodialysis = Diffusion based treatment Hemofiltration = Uses convection and solvent drag Continuous Renal Replacement Therapy (CRRT) = Performed for extended periods Hemodiafiltration (HDF) = Combines both diffusion and convection</p> Signup and view all the answers

    Which of the following is a complication associated with dialysis?

    <p>Hypotension</p> Signup and view all the answers

    Water treatment is necessary for both hemodialysis and hybrid therapies.

    <p>False</p> Signup and view all the answers

    What is the main characteristic of hybrid therapies in renal replacement therapy?

    <p>They combine both diffusion and convection techniques.</p> Signup and view all the answers

    The duration for intermittent hemodialysis typically lasts for ______ hours.

    <p>4-5</p> Signup and view all the answers

    What is the goal of the first treatment for a 10 kg dog, as mentioned in the content?

    <p>URR 40%, fluid removal 500ml in 5h</p> Signup and view all the answers

    What are the three main indications for dialytic intervention in AKI?

    <p>Serum creatinine exceeding 5 mg/dL (442 µmol/L) and trending higher in a hydrated animal.</p> Signup and view all the answers

    When is hemodialysis indicated for toxin removal?

    <p>When the molecular weight, protein binding, and volume of distribution of the toxin suggest removability.</p> Signup and view all the answers

    Chronic hemodialysis is commonly performed in animals.

    <p>False</p> Signup and view all the answers

    According to the provided text, what are the two main modalities for delivering renal replacement therapy in animals with AKI?

    <p>Continuous renal replacement therapy (CRRT) or Intermittent hemodialysis (IHD).</p> Signup and view all the answers

    Which of these is NOT a factor that dictates modality choice?

    <p>Pre-treatment urea levels</p> Signup and view all the answers

    What are the two types of extracorporeal renal replacement therapy (RRT)?

    <p>Intermittent hemodialysis (IHD)</p> Signup and view all the answers

    What is the main difference between peritoneal dialysis and hemodialysis/hemofiltration?

    <p>Peritoneal dialysis requires access to the peritoneal cavity and a dedicated catheter.</p> Signup and view all the answers

    Hybrid therapies combine the characteristics of both intermittent and continuous techniques.

    <p>True</p> Signup and view all the answers

    What is the primary mode of solute removal in hemodialysis?

    <p>Diffusion</p> Signup and view all the answers

    Hemofiltration relies on diffusion for solute removal.

    <p>False</p> Signup and view all the answers

    Hemodiafiltration combines both diffusive and convective processes.

    <p>True</p> Signup and view all the answers

    What are the three types of anticoagulation used in extracorporeal blood purification?

    <p>Systemic heparinization</p> Signup and view all the answers

    What are some considerations for assessing the risk of thrombotic complications?

    <p>Low blood flow rate</p> Signup and view all the answers

    Besides potential bleeding complications, what are the main problems associated with systemic heparinization?

    <p>Routine manipulations like handling the animal and potential need for urgent surgical or medical procedures.</p> Signup and view all the answers

    Regional anticoagulation is well-suited for treating critical care patients.

    <p>True</p> Signup and view all the answers

    What are some potential complications of dialysis?

    <p>Acid-base imbalances</p> Signup and view all the answers

    What are the goals of dialysis treatment?

    <p>To prevent further metabolic or organ dysfunction, maintain adequate fluid balance, and normalize electrolyte and acid-base balance.</p> Signup and view all the answers

    What are the three main reasons for hemodialysis in a patient with AKI?

    <p>High serum creatinine, anuria or oliguria, overhydration</p> Signup and view all the answers

    The main focus of hemodialysis in AKI is to alleviate the established morbidities and organ dysfunction caused by kidney injury.

    <p>False</p> Signup and view all the answers

    What is the most appropriate time to administer hemodialysis in AKI?

    <p>Proactively prior to multiorgan failure, not as a response to it.</p> Signup and view all the answers

    When is hemodialysis indicated for chronic kidney disease (CKD) in animals?

    <p>When medical management is not sufficient to control uremic manifestations, particularly when all other options have been exhausted</p> Signup and view all the answers

    Hemodialysis is indicated for toxin removal when there is an effective antidote available or a potentially more effective therapeutic modality.

    <p>False</p> Signup and view all the answers

    What are the key considerations regarding the suitability of a toxin for removal via hemodialysis?

    <p>Molecular weight, protein binding, and volume of distribution.</p> Signup and view all the answers

    What is the most efficient form of hemodialysis for removing toxins with a molecular weight less than 15,000 Da, protein binding less than 80%, and a volume of distribution (Vd) less than 2 L/kg?

    <p>High-efficiency IHD</p> Signup and view all the answers

    The size of the extracorporeal circuit should be greater than 20% of the animal's blood volume (BV).

    <p>False</p> Signup and view all the answers

    Study Notes

    Introduction to HD: Case Presentation

    • Ariane Schweighauser and Thierry Francey presented a case study
    • They are experts in small animal internal medicine and nephrology
    • They work at the Vetsuisse Faculty, University of Bern, Switzerland
    • The presentation is about best practices for intermittent hemodialysis in dogs and cats.

    Outline of the Presentation

    • Indications: Reasons for hemodialysis, such as acute kidney injury (AKI), chronic kidney disease (CKD), and intoxication
    • Modality: Different methods for treating kidney failure, such as intracorporeal (peritoneal dialysis) and extracorporeal (hemodialysis) methods, including intermittent, continuous, and hybrid approaches
    • Prescription: The specific treatment plan, including the amount, type, and timing of treatments.
    • Anticoagulation: Methods needed to prevent clotting during the procedures.
    • Complications: Potential issues with hemodialysis, such as hypotension, dialysis disequilibrium, and catheter-related issues
    • Outcome: The presentation includes prediction and results in specific cases such as the case study of Duke, a Labrador Retriever.

    Case Study: Duke the Labrador Retriever

    • A 3-month-old Labrador Retriever was presented with vomiting, diarrhea, anorexia.
    • Diagnosed with anuric AKI, grade 5, with 5% overhydration.
    • The dog also had hyperbilirubinemia (hepatic) and mild interstitial lung pattern.
    • Suspected severe acute leptospirosis (affecting 3 organ systems).
    • The case raises the question of whether dialysis is appropriate.

    Indications for Hemodialysis

    • Acute Kidney Injury (AKI): Dialysis is used when uremia is expected to cause severe metabolic or organ dysfunction, aiming to prevent rather than resolve established morbidity, ideally when underlying causes are reversible
    • Chronic Kidney Disease (CKD): Stage 4 CKD, when other treatments fail to manage uremic manifestations, is another indication for hemodialysis.
    • Intoxication: Dialysis is used in situations with no effective antidote or alternative treatment when toxin concentration threatens morbidity, life, or tissue

    Dialysis Modalities in the Presentation

    • Intracorporeal: Peritoneal dialysis (PD).
    • Extracorporeal: Continuous renal replacement therapy (CRRT) including intermittent hemodialysis (IHD), hybrid forms (including PIRRT and HDF).

    Segev Scoring Model

    • The Segev model is cited, but not well explained
    • The model helps predict the outcome from kidney disease

    Outcome Prediction for Duke

    • Long term outcome of cats and dogs treated with intermittent hemodialysis for acute kidney injury was approximately 42% at 30 days and 33% at one year.
    • An outcome prediction score of 9.9% likelyhood of survival is indicated.

    Specifics of the Hemodialysis Procedures in the Presentation

    • Duration of Treatment: The presentation displays the typical duration of intermittent hemodialysis (IHD), prolonged intermittent renal replacement therapy (PIRRT), and continuous renal replacement therapy(CRRT)
    • Modality Selection: The choice of hemodialysis modality is influenced by medical considerations (azotemia, fluid overload), platform availability, staff expertise, staff resources and expected treatment duration.

    Anticoagulation and Complications

    • Anticoagulation is essential with extracorporeal circulation.
    • Anticoagulation is needed to prevent clotting, and appropriate methods are needed are selected based on risks.
    • Complications of hemodialysis include hypotension, thrombosis, arrhythmias, dialysis disequilibrium.

    Additional Considerations

    • The presentation emphasizes the importance of thoroughly assessing the animal's history and condition before proceeding with dialysis.
    • The outcome of Duke, a 10kg dog, includes treatment duration and details of creatinine levels over 8 days of hospitalization.
    • Considerations about the adequacy of treatment and overall care are highlighted.

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    Related Documents

    Case Presentation 23 Sep 2024 (PDF)
    International Renal Interest Society Best Practice Guidelines for Intermittent Hemodialysis in Dogs and Cats PDF

    Description

    This quiz covers the key aspects of intermittent hemodialysis in dogs and cats as presented by experts in veterinary medicine. It highlights indications for treatment, various modalities, prescription details, anticoagulation methods, and potential complications associated with hemodialysis. Perfect for those studying small animal internal medicine.

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