Renal Replacement Therapy in Veterinary Patients
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Questions and Answers

What is the proposed unifying link for prescription and outcome assessment in renal replacement therapies?

  • Patient age and weight
  • Standardized treatment duration
  • Delivery of urea clearance (correct)
  • Total body fluid volume

    • Which of the following renal replacement therapy techniques is considered standard?

  • Oral fluid therapy
  • Continuous hydration therapy
  • Ultrafiltration therapy
  • Intermittent hemodialysis (correct)

    • Why is there a need to reevaluate prescription criteria in renal replacement therapies?

  • Standard protocols eliminate the need for monitoring
  • Current guidelines meet all patient needs
  • All renal failure cases are the same
  • Technological advancements have changed treatment options (correct)

    • What is the role of veterinary IHD hybrid treatments?

    <p>To establish comparable guidelines for outcome assessments</p> Signup and view all the answers

    What significant change is noted regarding conventional guidelines for renal replacement therapy?

    <p>They are outdated and need reassessment</p> Signup and view all the answers

    What does the acronym CRRT stand for in the context of renal replacement therapy?

    <p>Continuous renal replacement therapy</p> Signup and view all the answers

    Which type of therapy is NOT mentioned as standard in the document?

    <p>Home-based renal monitoring</p> Signup and view all the answers

    Which mathematical relationship is referred to in the context of delivered urea clearance?

    <p>Urea reduction ratio and fractional patient urea clearance</p> Signup and view all the answers

    What is the primary goal of Regional Anticoagulation in critical patients with active bleeding?

    <p>To confine anticoagulation to extracorporeal blood</p> Signup and view all the answers

    Which complication is specifically related to cardiovascular issues during dialysis?

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

    What is the target Urea Reduction Ratio (URR) for solute removal in Duke’s treatment?

    <p>40%</p> Signup and view all the answers

    What is the main focus of metabolic complications during dialysis?

    <p>Electrolyte and acid-base disturbances</p> Signup and view all the answers

    Which of the following reflects the correct blood flow (Qb) rate used in Duke's treatment modality?

    <p>10 mL/min</p> Signup and view all the answers

    What was the duration of Duke's hospitalization for dialysis sessions?

    <p>8 days</p> Signup and view all the answers

    During Duke's treatment, what was the volume of fluid aimed for removal in 5 hours?

    <p>500 mL</p> Signup and view all the answers

    Which factors should be considered when assessing whether Duke's overall care was sufficient?

    <p>Survival, renal recovery, and residual damage</p> Signup and view all the answers

    What does Renal Replacement Therapy (RRT) prescriptions require to meet individual patient needs?

    <p>Adaptation to changing requirements during dialysis sessions</p> Signup and view all the answers

    What is the primary indicator of dialysis efficacy in relation to uremia?

    <p>The clearance of small solutes such as urea</p> Signup and view all the answers

    Which measurement is used to assess the intensity of urea clearance in Continuous Renal Replacement Therapy (CRRT)?

    <p>Normalized effluent volume (mL/kg/hr)</p> Signup and view all the answers

    What is a significant limitation of the Urea Reduction Ratio (URR) in veterinary therapy?

    <p>It oversimplifies solute transfer during dialysis.</p> Signup and view all the answers

    What has been the traditional operational parameter guiding dialysis prescriptions in veterinary medicine?

    <p>Total blood processed (Qbt)</p> Signup and view all the answers

    Which factors affect the relationship between blood flow rate (Qb) and urea clearance (Kd) at low flow rates?

    <p>Lower Qb resulting in higher urea extraction</p> Signup and view all the answers

    What is the perceived drawback of using current veterinary dialysis guidelines based on kinetic modeling?

    <p>They are less applicable for patients with acute kidney injury.</p> Signup and view all the answers

    In veterinary intermittent hemodialysis (IHD), what is used to predict treatment intensity?

    <p>Total blood processed predictions based on Qbt</p> Signup and view all the answers

    What is a potential outcome from the limitations of current IHD practice patterns?

    <p>Little recognition of clearance beyond URR</p> Signup and view all the answers

    Which characteristic of hybrid dialysis treatments on CRRT platforms is noted?

    <p>Decreased urea clearance intensity over time</p> Signup and view all the answers

    What key element is emphasized in prescribing dialysis treatment regimens?

    <p>Patient's urea clearance delivered</p> Signup and view all the answers

    What is a proposed clinical strategy for improving dialysis prescription?

    <p>Introduction of a prescription calculator for uniformity</p> Signup and view all the answers

    What factor is primarily affected by membrane characteristics during high blood flow rates in dialysis?

    <p>Urea clearance</p> Signup and view all the answers

    What indicates the efficacy of hybrid therapies in veterinary dialysis?

    <p>Clear identification of design limitations impacting clinical outcomes</p> Signup and view all the answers

    What does the effective processed blood volume during IHD bypass modalities refer to?

    <p>The blood volume processed when the machine is 'out of bypass'.</p> Signup and view all the answers

    In low-intensity dialysate-based IHD modalities, what variable predicts the required dialysate flow rate?

    <p>Effective volume of blood processed divided by treatment time.</p> Signup and view all the answers

    What is the correlation between the slow dialysate flow rate (Qd) and the hemodialyzer clearance (Kd)?

    <p>Qd equals Kd if the dialyzer is completely saturated during transit.</p> Signup and view all the answers

    What is a common outcome link across various IHD modalities?

    <p>Patient urea clearance.</p> Signup and view all the answers

    What defines the indications for hemodialysis in patients with acute kidney injury?

    <p>Intervention when uremia leads to severe metabolic dysfunction.</p> Signup and view all the answers

    What is a challenge associated with systemic heparinization during hemodialysis?

    <p>It can lead to bleeding risks and complications.</p> Signup and view all the answers

    What types of kidney issues typically require hemodialysis as a bridge to recovery?

    <p>Severe metabolic or organ dysfunction due to reversible Acute Kidney Injury (AKI).</p> Signup and view all the answers

    For hybrid therapies on a CRRT platform, which parameter is crucial for prescription?

    <p>Patient urea clearance.</p> Signup and view all the answers

    What are the primary modes of renal replacement therapy (RRT) mentioned?

    <p>Extracorporeal and intracorporeal methods.</p> Signup and view all the answers

    What is the predicted 30-day survival rate for Duke based on Segev Model C?

    <p>42%</p> Signup and view all the answers

    What is the primary mechanism of hemodialysis in removing waste products?

    <p>Diffusion across a semi-permeable membrane.</p> Signup and view all the answers

    Which factors primarily influence the efficiency of hemodialysis in removing toxins?

    <p>Concentration gradients of solutes and ultrafiltration rates.</p> Signup and view all the answers

    What is the primary complication associated with peritoneal dialysis compared to hemodialysis?

    <p>More invasive procedure requiring surgical access.</p> Signup and view all the answers

    What encompasses hybrid therapies in renal replacement therapy?

    <p>Combination of intermittent and continuous techniques.</p> Signup and view all the answers

    Study Notes

    Renal Replacement Therapy in Veterinary Patients

    • Renal replacement therapies (RRT) are advanced standards for managing acute and chronic kidney failure in dogs and cats.
    • Conventional guidelines are outdated and require reevaluation.
    • Urea clearance serves as a unifying factor for prescription and outcome assessment across different RRT platforms.
    • Standard venous dialytic techniques include intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT).
    • Veterinary IHD hybrid treatments offer comparable outcome assessments across platforms, tailored to individual patient needs, and adapting during sessions.
    • RRT must accommodate diverse patient sizes and phases of kidney failure, azotemia, and fluid imbalances.
    • Blood purification relies on removing toxins into dialysate.
    • Dialysis efficacy is mostly characterized by small solute removal such as urea.
    • Current veterinary guidelines are based on kinetic modelling and may be less applicable with acute kidney injury (AKI).
    • AKI patients often present with variable nitrogen balance and solute distribution, making traditional kinetic modelling unsuitable.
    • Empirical methods like Urea Reduction Ratio (URR) estimates are frequently used in veterinary medicine, despite limitations.
    • A clinical strategy and prescription calculator can improve extracorporeal RRT.

    Case Study: Duke (Labrador Retriever, 3 months old)

    • Presented with: Vomiting, diarrhea, anorexia (3 days), anuric AKI, Grade 5 (5% overhydration), hyperbilirubinemia (hepatic), mild interstitial lung pattern, suspected severe leptospirosis.
    • Indications for Hemodialysis:
      • Severe AKI or acute-on-chronic kidney disease (ACKD)
      • Reversible AKI as a "bridge to recovery"
      • Chronic kidney disease (CKD), Stage 4 CKD, not manageable via medical treatment.
      • Intoxication when no other treatment option exists for life-threatening exposure.

    Outcome Prediction for Duke

    • Segev Model C score: 17.2
    • Predicted 30-day survival: 42%
    • Predicted 1-year survival: 33%
    • Overall survival likelihood: Significantly decreased (9.9%) due to azotemia and organs involved.

    Treatment of Duke

    • Modality: Intermittent Hemodialysis (IHD)
    • IHD Goals:
      • Urea Reduction Ratio (URR) target 40%
      • Fluid removal target: 500 mL in 5 hours
      • Prescribed blood flow (Qb): 10 mL/min
      • Prescribed dialysate flow (Qd): 300 mL/min
    • Treatment course: Underwent 3 IHD sessions in 8 days of hospitalization

    Hemodialysis Principles

    • Hemodialysis relies on diffusion across a semi-permeable membrane to remove low-molecular-weight solutes like urea and creatinine.
    • Ultrafiltration (UF) is employed to remove fluid overload by creating pressure differences.

    Anticoagulation

    • Systemic heparinization (SH) is often used but faces challenges.
    • Regional anticoagulation (RA) is a safer choice for critical patients with active bleeding, limiting the anticoagulant's effects to the extracorporeal circuit.

    Complications of Dialysis

    • Cardiovascular (hypotension, arrhythmias)
    • Hemostasis (bleeding, thrombosis)
    • Neurological (dialysis disequilibrium syndrome, cerebral edema)
    • Technical (machine/catheter problems)
    • Metabolic (electrolyte and acid-base imbalances)

    Further Note

    • Treatment adequacy and overall care consideration include survival, renal recovery, residual organ damage, and multi-organ management.

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    Description

    This quiz focuses on the advancements in renal replacement therapy (RRT) for managing kidney failure in dogs and cats. It highlights the limitations of conventional guidelines and discusses various therapeutic techniques, including intermittent hemodialysis and continuous renal replacement therapy. Additionally, it explores the importance of individual patient assessments and the efficacy of blood purification methods.

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