International Renal Interest Society Best Practice Guidelines for Intermittent Hemodialysis in Dogs and Cats PDF

The Veterinary Journal 305 (2024) 106092 Contents lists available at ScienceDirect The Veterinary Journal...

The Veterinary Journal 305 (2024) 106092 Contents lists available at ScienceDirect The Veterinary Journal journal homepage: www.elsevier.com/locate/tvjl International renal interest society best practice consensus guidelines for intermittent hemodialysis in dogs and cats Gilad Segev a, *, Jonathan D. Foster b, Thierry Francey c, Catherine Langston d, Ariane Schweighauser c, Larry D. Cowgill e a Koret School of Veterinary Medicine, The Robert H. Smith Faculty of Agriculture, Food and Environment, Hebrew University of Jerusalem, Israel b Department of Nephrology and Urology, Friendship Hospital for Animals, Washington DC, USA c Department of Clinical Veterinary Medicine, Vetsuisse Faculty University of Bern, Bern, Switzerland d Veterinary Clinical Science, The Ohio State University, Columbus, OH, USA e Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA, USA A R T I C L E I N F O A B S T R A C T Keywords: Intermittent hemodialysis (IHD) is an advanced adjunctive standard of care for severe acute kidney injury (AKI) Acute kidney injury and other indications. Most animals with AKI are managed medically, however, when the disease is severe, Hemodialysis medical management may not control the consequences of the disease, and animals with a potential for renal Extracorporeal recovery may die from the consequences of uremia before recovery has occurred. Extracorporeal therapies aid Canine Feline the management of AKI by expanding the window of opportunity for recovery of sufficient kidney function to become dialysis independent. Intermittent hemodialysis (IHD) was introduced into veterinary medicine over 50 years ago, however, updated guidelines for the delivery of IHD have not been published for several decades. To that end, the International Renal Interest Society (IRIS) constituted a Working Group to establish best practice guidelines for the safe and effective delivery of IHD to animals with indications for dialytic intervention. The IRIS Working Group generated 60 consensus statements and supporting rational for a spectrum of prescription and management categories required for delivery of IHD on designated intermittent dialysis platforms (i.e., AKI, chronic hemodialysis and intoxications). A formal consensus method was used to validate the recommendations by a blinded jury of 12 veterinarians considered experts in extracorporeal therapies and actively performing IHD. Each vote provided a level of agreement for each recommendation proposed by the Working Group. To achieve a consensus, a minimum of 75% of the voting participants had to “strongly agree” or “agree” with the recommendation. Introduction despite potential reversibility of AKI. Adjunctive hemodialysis should be introduced in a timely manner to the medical management, when Intermittent hemodialysis (IHD) is an advanced adjunctive standard medical treatment alone is not expected to control the clinical signs and of care for severe acute kidney injury (AKI) and other indications in morbid clinicopathologic abnormalities associated with the AKI. He­ which medical therapy fails to correct life-threatening azotemia, fluid modialysis also is indicated for elimination of selected toxins in cases of overload, or dysregulated body fluid composition or intoxications. Se­ intoxications independent of kidney function. In these circumstances a vere acute kidney injury (AKI) is associated with high morbidity and careful assessment should be performed to determine whether dialytic mortality with reported mortality of 35%-60% in animals managed intervention is indicated (e.g., level of toxicity, toxin half-life, avail­ medically or with hemodialysis (Vaden et al., 1997; Worwag and ability of antidote), and whether hemodialysis is expected to effectively Langston, 2008; Eatroff et al., 2012; Rimer et al., 2022). Medical man­ remove the toxin (Foster, 2020). agement alone often is ineffective to control the clinical signs and Modalities for the delivery of renal replacement therapy include metabolic abnormalities of uremia when the AKI is severe. Conse­ peritoneal dialysis, IHD, and continuous renal replacement therapy quently, animals are at risk of dying within a short therapeutic window, (CRRT). Over the last few decades, extracorporeal renal replacement * Corresponding author. E-mail address: [email protected] (G. Segev). https://doi.org/10.1016/j.tvjl.2024.106092 Received 11 June 2023; Received in revised form 24 February 2024; Accepted 28 February 2024 Available online 3 March 2024 1090-0233/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). G. Segev et al. The Veterinary Journal 305 (2024) 106092 therapies have become more widely available in veterinary medicine. indications for dialytic intervention in AKI are: IHD was the first extracorporeal renal replacement therapy introduced to veterinary therapeutics and remains an effective advanced treatment Serum creatinine exceeding 5 mg/dL (442 µmol/L) and trending option for AKI with growing acceptance. Despite its established inte­ higher in a hydrated animal. gration into veterinary therapeutics, updated veterinary guidelines for Persistent (>6 h) anuria or oliguria (