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 (B)

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 (D)</p> Signup and view all the answers

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

<p>True (A)</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 (A), Persistent anuria or oliguria (B)</p> Signup and view all the answers

Peritoneal dialysis requires specific medical equipment for its procedure.

<p>False (B)</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 (D)</p> Signup and view all the answers

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

<p>True (A)</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) (D)</p> Signup and view all the answers

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

<p>False (B)</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 (C)</p> Signup and view all the answers

Water treatment is necessary for both hemodialysis and hybrid therapies.

<p>False (B)</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 (B)</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. (A), Persistent (&gt;6 h) anuria or oliguria (&lt;0.3 mL/kg/h) unresponsive to appropriate fluid therapy and medical management. (B), Severe and life-threatening overhydration unresponsive to diuretic therapy and promoting target organ damage. (C), Presence of electrolyte disturbances which cannot be controlled with medical or surgical management (e.g., hyperkalemia severe enough to compromise cardiac function). (D), All of the above. (E)</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. (A), When there is no effective antidote or a potentially more effective therapeutic modality. (B), When the suspected toxin concentration is sufficient to cause morbidity, life-threatening risk, or tissue damage. (C)</p> Signup and view all the answers

Chronic hemodialysis is commonly performed in animals.

<p>False (B)</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 (E)</p> Signup and view all the answers

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

<p>Intermittent hemodialysis (IHD) (B), Continuous renal replacement therapy (CRRT) (D)</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. (A), Hemodialysis/hemofiltration require specific medical equipment. (B)</p> Signup and view all the answers

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

<p>True (A)</p> Signup and view all the answers

What is the primary mode of solute removal in hemodialysis?

<p>Diffusion (A)</p> Signup and view all the answers

Hemofiltration relies on diffusion for solute removal.

<p>False (B)</p> Signup and view all the answers

Hemodiafiltration combines both diffusive and convective processes.

<p>True (A)</p> Signup and view all the answers

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

<p>Systemic heparinization (A), Anticoagulation-free (B), Minimal heparin (C), Regional anticoagulation (D)</p> Signup and view all the answers

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

<p>Low blood flow rate (A), Large-bore central venous catheters (B), Glomerular disease (C), CKD or AKI (D), High PCV (E), Extracorporeal systems with drip chambers for pressure monitoring (F), Intradialytic administration of blood products or lipid preparations (G), High ultrafiltration rate (H), Access recirculation (I)</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 (A)</p> Signup and view all the answers

What are some potential complications of dialysis?

<p>Acid-base imbalances (A), Electrolyte imbalances (B), Catheter infection (C), Bleeding (D), Thrombosis (E), Hypotension (F), Arrhythmias (G), Machine malfunction (H), Dialysis disequilibrium (I), Metabolic disturbances (J)</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 (A)</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 (B)</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 (C)</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 (B)</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 (B)</p> Signup and view all the answers

Flashcards

Continuous Renal Replacement Therapy (CRRT)

A renal replacement therapy that is administered continuously over a period of time, typically hours or days, instead of intermittently.

Hybrid Therapies

Renal replacement therapies that combine characteristics of both intermittent and continuous techniques in treatment frequency, duration and modality.

Prolonged Intermittent Daily Renal Replacement Therapy (PIRRT)

A type of renal replacement therapy done intermittenly over a long period, often a daily basis.

Sustained Low-Efficiency Dialysis (SLED)

A type of renal replacement therapy that is done continuously and with a low efficiency rate.

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Hemodialysis (HD)

A method of renal replacement therapy that uses a dialyzer to remove waste products from the blood outside of the body.

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Peritoneal Dialysis (PD)

A renal replacement therapy that uses the lining of the abdomen to filter waste products and excess fluid from the blood.

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Choice of modality for renal replacement therapy

The decision to use a particular renal replacement therapy (e.g., hemodialysis, peritoneal dialysis, CRRT) based on patient condition and available resources.

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Dialyzer

A medical device used in hemodialysis to filter blood.

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Anuria/Oliguria (>6 hrs)

The absence or significantly reduced urine production for more than six hours.

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Intracorporeal RRT

Renal replacement therapy performed inside the body (e.g., peritoneal dialysis).

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Extracorporeal RRT

Renal replacement that uses a machine outside the body to filter blood (e.g., hemodialysis, CRRT).

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Hemodialysis

A type of renal replacement therapy where blood is filtered by a machine outside the body.

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Indications for Dialysis

Reasons to start dialysis treatment (e.g., severe kidney failure).

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Segev Score

Scoring system of kidney disease.

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Hemofiltration (HF)

A blood purification technique using convection and solvent drag to remove waste products.

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Hybrid Therapies (HDF)

Combines diffusive and convective techniques for blood purification.

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Diffusion

Movement of solutes from a high concentration to a low concentration across a semi-permeable membrane.

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Convection

Process of moving fluids, and solutes with the fluid, from high to low pressure or across a semipermeable device.

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Continuous Venovenous Hemofiltration (CVVH)

Method that uses convection to remove waste from blood.

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Continuous Venovenous Hemodiafiltration (CVVHDF)

A continuous method that use both diffusion and convection to purify blood.

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Intermittent Hemodialysis (IHD)

Method of dialysis that is done for a limited time.

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Ultrafiltration

Process of removing fluids from the blood.

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AKI

Acute kidney injury is a sudden decrease in kidney function. It occurs when the kidneys can't filter waste from the blood properly.

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IHD

Intermittent hemodialysis (IHD) is a treatment where blood is filtered outside the body for a limited time, several times a week.

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Azotemia

Azotemia is a buildup of waste products in the blood, primarily urea nitrogen, due to kidney dysfunction.

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Uremia

Uremia is a condition where the blood contains high levels of waste products from kidney dysfunction.

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Fluid Overload

Fluid overload occurs when the body retains too much fluid, which can lead to heart problems and other complications.

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Indications for IHD

Indications for IHD are medical reasons why it is needed, such as severe AKI, fluid overload, or toxin removal.

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Medical Management of AKI

Medical management focuses on treating the underlying cause of AKI and providing supportive care.

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Dialytic Intervention

Dialytic intervention involves using dialysis to filter the blood when medical management fails to control AKI.

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Therapeutic Window

Therapeutic window refers to the limited timeframe when treatment interventions can still be effective.

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Morbidity and Mortality

Morbidity refers to illness or disease, while mortality refers to death. These are important factors in determining the effectiveness of treatments.

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Antidote

An antidote is a substance that counteracts the effects of a poison or toxin.

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Half-Life of a Toxin

Half-life of a toxin is the time it takes for the concentration of the toxin to decrease by half in the body.

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Renal Replacement Therapy (RRT)

RRT refers to various methods, like dialysis, that take over the functions of the kidneys when they fail.

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Extracorporeal Therapies

Extracorporeal therapies involve filtering blood outside of the body using machines.

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Integration into Veterinary Therapeutics

This refers to IHD becoming a standard treatment option in veterinary medicine.

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Serum Creatinine

Serum creatinine is a waste product measured in the blood, indicating kidney function.

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Anuria/Oliguria

Anuria is the absence of urine production, while oliguria is a decrease in urine output.

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Hydrated Animal

A hydrated animal has adequate water in its body.

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Trend Higher

Trend higher means that the serum creatinine level is steadily increasing over time.

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Persistent

Persistent refers to something that continues for a long time, like anuria or oliguria lasting for more than six hours.

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Toxicology

Toxicology is the study of how poisons and toxins affect the body.

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Half-Life

Half-life is the time it takes for a substance to decrease by half in the body.

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Dialysis Platforms

Dialysis platforms refer to different types of dialysis equipment or systems used for treatment.

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IRIS Working Group

IRIS is a group of veterinary experts specializing in kidney disease.

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Consensus Statements

Consensus statements are agreements reached by the IRIS Working Group on best practices for IHD treatment.

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Blinded Jury

A blinded jury is a group of experts who evaluate recommendations without knowing who made them.

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Acute Kidney Injury (AKI)

A sudden, serious decline in kidney function, often leading to a buildup of waste products in the blood.

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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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