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 (D)</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They are outdated and need reassessment (A)</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 (D)</p> Signup and view all the answers

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

<p>Home-based renal monitoring (A)</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 (D)</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 (D)</p> Signup and view all the answers

Which complication is specifically related to cardiovascular issues during dialysis?

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

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

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

What is the main focus of metabolic complications during dialysis?

<p>Electrolyte and acid-base disturbances (A)</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 (D)</p> Signup and view all the answers

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

<p>8 days (B)</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 (C)</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 (B)</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 (B)</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 (A)</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) (D)</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. (A)</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) (D)</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 (D)</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. (D)</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 (A)</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 (D)</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 (C)</p> Signup and view all the answers

What key element is emphasized in prescribing dialysis treatment regimens?

<p>Patient's urea clearance delivered (D)</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 (A)</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 (A)</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 (C)</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'. (B)</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. (D)</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. (C)</p> Signup and view all the answers

What is a common outcome link across various IHD modalities?

<p>Patient urea clearance. (B)</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. (B)</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. (A)</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). (A)</p> Signup and view all the answers

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

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

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

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

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

<p>42% (C)</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. (D)</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. (A)</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. (C)</p> Signup and view all the answers

What encompasses hybrid therapies in renal replacement therapy?

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

Flashcards

Renal Replacement Therapy (RRT)

The removal of waste products and excess fluid from the blood by an artificial kidney machine. It's a life-saving treatment for animals with kidney failure.

Intermittent Hemodialysis (IHD)

A type of RRT where blood is filtered through a machine for a short period, similar to human hemodialysis.

Delivered Urea Clearance

One of the key goals of RRT prescription is to achieve a certain level of waste removal from the blood, measured by how much urea is cleared.

Continuous Renal Replacement Therapy (CRRT)

A newer type of RRT where blood is filtered continuously, often used for animals that need ongoing blood cleaning.

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CRRT for Severe Kidney Failure

CRRT is frequently used for animals with severe kidney failure who require continuous support. It's like a life-support machine for the kidneys.

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Choosing the Right RRT

Both IHD and CRRT have specific strengths and weaknesses. Choosing the best type for an animal depends on its condition and needs.

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Evolving Approach to RRT

The approach of RRT is changing, moving towards a more standardized way to prescribe RRT based on how well the blood is being cleaned.

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Standardized Guidelines for RRT

Veterinarians are working on creating guidelines and benchmarks to ensure that RRT is prescribed and evaluated consistently.

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Hemodialysis (HD)

A type of dialysis that uses a machine to filter blood outside the body. It involves inserting a needle into a vein to draw blood, sending it through a filter, and returning it to the body.

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Regional Anticoagulation (RA)

A technique that limits anticoagulation to the blood being filtered in the dialysis machine, reducing the risk of bleeding in critical patients.

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Urea Reduction Ratio (URR)

A measurement of how much urea is removed from the blood during dialysis, indicating the effectiveness of the treatment.

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Dialysis Disequilibrium

A potential complication of dialysis that occurs when fluid and electrolytes shift rapidly, leading to brain swelling.

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Dialysis Treatment Goals

The goal of dialysis treatment is to remove waste products and excess fluid from the blood.

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Blood Flow (Qb)

The amount of blood flowing through the dialysis machine per minute, crucial for efficient filtration.

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Dialysate Flow (Qd)

The amount of dialysis fluid flowing through the machine per minute, which affects filtration efficiency.

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What is Renal Replacement Therapy (RRT)?

Renal replacement therapy (RRT) is a medical treatment that replaces the function of the kidneys when they are no longer working properly. It includes various therapies, including dialysis.

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What is Dialysis?

Dialysis is a medical procedure used to remove waste products and excess fluid from the blood when the kidneys are not working properly.

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What is Urea?

Urea is a waste product produced by the body that is normally eliminated through urine by the kidneys. In kidney failure, urea accumulates in the blood.

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What is Urea Clearance (Kt/V)?

Urea clearance (Kt/V) is a measure of how effectively dialysis removes urea from the blood. It is calculated based on the volume of blood filtered (V) and the rate of urea removal (K) during dialysis.

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What is Urea Reduction Ratio (URR)?

Urea Reduction Ratio (URR) is a simplified measure of how much urea is removed from the blood during dialysis. It is calculated as the percentage reduction in urea concentration.

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What is Intermittent Hemodialysis (IHD)?

Intermittent Hemodialysis (IHD) is a type of dialysis that is performed for a few hours, usually 3-4 times per week. It is typically given to patients with chronic kidney failure.

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What is Continuous Renal Replacement Therapy (CRRT)?

Continuous Renal Replacement Therapy (CRRT) is a type of dialysis that is performed continuously for 24 hours a day. It is typically given to patients with acute kidney injury or critically ill patients with kidney failure.

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What are Hybrid Dialysis Therapies?

Hybrid dialysis therapies combine elements of both IHD and CRRT. They aim to provide benefits of both methods, such as flexibility and shorter treatment times.

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What is Azotemia?

Azotemia is a medical condition in which there is an abnormal buildup of nitrogenous waste products, particularly urea, in the blood. It is a common symptom of kidney failure.

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What is Total Blood Processed (Qbt)?

Total Blood Processed (Qbt) is a commonly used measure in IHD. It reflects the total volume of blood that has passed through the dialysis machine during a treatment session.

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What is Qb (Blood Flow Rate)?

Qb (blood flow rate) refers to the rate at which blood is pumped through the dialysis machine during a treatment session.

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What is Kd (Dialyzer Clearance)?

Kd is a measure of the hemodialyzer's ability to remove urea from the blood. It varies depending on the type of hemodialyzer and the blood flow rate used.

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What is Kdt (Total Clearance)?

Kdt is a measure of the total clearance achieved by the dialysis system during a treatment session. It takes into account both the dialyzer clearance (Kd) and the time (t) of dialysis.

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What are the limitations of URR-based IHD prescriptions?

Veterinary IHD prescriptions are mainly based on URR predictions from Qbt. This empirical method, while widely used, has limitations in accurately reflecting true clearance and patient-specific needs.

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Hemodialysis for CKD (Chronic Kidney Disease)

Used when medical and biochemical abnormalities in CKD become too much to manage with medication, it's a critical decision for patient survival.

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Extracorporeal Renal Replacement Therapy (RRT)

This modality deals directly with removing waste products and excess fluid from the blood.

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Hemodialysis (HD) Principle

This process focuses on diffusing small molecules across a membrane, removing waste and toxins.

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Ultrafiltration (UF)

This involves removing excess fluid from the body using pressure gradients.

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Hybrid Therapies

This approach combines benefits of IHD and CRRT, offering flexibility for different patients.

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Segev Model C for Outcome Prediction

The Segev Model C estimates the likelihood of an animal surviving 30 days, 1 year, and overall based on factors like disease and organ involvement.

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Delivered Urea Clearance for Hybrid Therapies

Delivered urea clearance is a crucial prescription parameter for hybrid therapies like PIRRT and CRRT.

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Dialysate Flow Rate (Qd) Control

This approach uses the dialysate flow rate to control the desired urea reduction ratio (URR) in low-intensity PIRRT.

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Effective Processed Blood Volume

A crucial factor in IHD bypass modalities, it's the volume of blood processed during the out-of-bypass time, not the total volume.

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Effective Volume of Blood to Process

This refers to the volume of blood processed divided by treatment time, predicting the required dialysate flow rate for desired URR.

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Total Blood Passed Through Hemodialyzer

A key prescription parameter in IHD, it's the volume of blood passing through the hemodialyzer, including bypass and out-of-bypass periods.

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Complete Dialyzer Saturation

This occurs when the dialyzer is fully saturated during blood transit, leading to a slow dialysate flow rate.

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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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