Applicability of the drainage effectiveness of Blake drains and Tenckhoff catheters in the peritoneal dialysis of healthy rabbits (Oryctolagus cuniculus).

OBJECTIVE: To compare the efficacy of dialysate drainage between Tenckhoff (TC) catheter and Blake (BL) in peritoneal dialysis (PD) in healthy rabbits. DESIGN: Prospective experimental study. SETTING: University Teaching Hospital and University research laboratory. ANIMALS: Twenty healthy, male, New Zealand rabbits. INTERVENTIONS: PD via the TC catheter and the BL abdominal drain was compared during 3 consecutive days of dialysis delivery. MEASUREMENTS AND MAIN RESULTS: One session of PD was performed per day for 3 consecutive days (S1: first session, S2: second session, S3: third session) and each session included 4 cycles of infusion, dwell of dialysate in the abdomen, and drainage. Data collection included daily urea, creatinine, alanine aminotransferase, albumin, and potassium, in addition to hematological parameters (eg, RBC, HCT, hemoglobin, WBC, and platelet count). Statistical analysis using a mixed linear model with multiple comparisons was performed. The BL drain resulted in an increase in volume drained (ml/kg) when compared to TC catheter on S2 (third and fourth cycles) and S3 (first and second cycles). CONCLUSIONS: The BL drain proved to be superior to the TC catheter, being capable of draining a larger volume of dialysate during the drainage processes in the peritoneal PD of healthy rabbits. The TC catheter had major complications with regard to fluid retention in the abdomen, representing reduced drainage efficiency, while the BL drain showed a greater tendency for the peritoneal fluid to leak.

Successful non-invasive management of iatrogenic splenic injury associated with a peritoneal dialysis catheter in a dog.

An 11-month-old, intact female Labrador retriever was presented with oligoanuric acute kidney injury and overhydration after grape ingestion. Percutaneous placement of a 12G × 30 cm Mila chest tube was done as an emergency temporary peritoneal dialysis catheter. Although no serious immediate complications were noted, an iatrogenic splenic injury had occurred. The catheter was used for peritoneal dialysis and urine output and hydration status improved over time. When the dialysis catheter was removed 3 d later, a synthetic hemostatic matrix, Surgiflo, was deposited through the catheter. No complications were noted. The dog recovered uneventfully and was doing well with normal kidney function. Key clinical message: To the authors' knowledge, this report represents the first description of non-invasive management of iatrogenic splenic injury secondary to percutaneous peritoneal dialysis catheter placement in a dog.

Prise en charge non invasive réussie de lésions spléniques iatrogènes associées à un cathéter de dialyse péritonéale chez un chien. Une femelle Labrador retriever intacte âgée de 11 mois a été présentée avec une lésion rénale aiguë oligoanurique et une surhydratation après ingestion de raisin. La mise en place percutanée d'un drain thoracique Mila de 12G × 30 cm a été réalisée en tant que cathéter de dialyse péritonéale temporaire d'urgence. Bien qu'aucune complication immédiate grave n'ait été notée, une lésion splénique iatrogène s'était produite. Le cathéter a été utilisé pour la dialyse péritonéale et le débit urinaire et l'état d'hydratation se sont améliorés au fil du temps. Lorsque le cathéter de dialyse a été retiré 3 jours plus tard, une matrice hémostatique synthétique Surgiflo a été déposée via le cathéter. Aucune complication n'a été notée. Le chien a récupéré sans incident et se portait bien avec une fonction rénale normale.Message clinique clé:À la connaissance des auteurs, ce rapport représente la première description de la gestion non invasive de lésions spléniques iatrogènes secondaires à la pose d'un cathéter de dialyse péritonéale percutanée chez un chien.(Traduit par Dr Serge Messier).

Severe hyperkalemia presenting with wide-complex tachycardia in a puppy with acute kidney injury secondary to leptospirosis.

OBJECTIVE: To describe a case of hyperkalemia coinciding with wide-complex tachycardia (WCT) in a dog with acute kidney injury secondary to leptospirosis infection. CASE SUMMARY: An 11-week-old Golden Retriever-Standard Poodle cross puppy was referred for acute kidney injury and hepatopathy. WCT coinciding with marked hyperkalemia was identified on presentation. Tachycardia persisted until resolution of hyperkalemia. NEW OR UNIQUE INFORMATION PROVIDED: To our knowledge, this is the first report of severe hyperkalemia presenting with WCT in a dog. Hyperkalemia should be considered a differential for WCT in dogs.

Current techniques in peritoneal dialysis.

OBJECTIVE: To provide a current overview of the technique of peritoneal dialysis in dogs and cats. CLINICAL IMPLICATION: Peritoneal dialysis is the process by which water and solutes move between blood in the peritoneal capillaries and fluid (dialysate) instilled into the peritoneal cavity, across the semipermeable membrane of the peritoneum. The primary indication for peritoneal dialysis (PD) in animals is for treatment of renal failure to correct water, solute, and acid-base abnormalities and to remove uremic toxins. SUMMARY: Peritoneal dialysis is a modality of renal replacement therapy commonly used in human medicine for the treatment of chronic kidney disease and end-stage kidney failure. Peritoneal dialysis utilizes the peritoneum as a membrane across which fluids and uremic solutes are exchanged. Dialysate is instilled into the peritoneal cavity and, through the process of diffusion and osmosis, water, toxins, electrolytes, and other small molecules are allowed to equilibrate.

Laparoscopic-assisted placement of a peritoneal dialysis catheter with partial omentectomy and omentopexy in dogs: an experimental study.

OBJECTIVE: To describe a technique of laparoscopic-assisted placement of a peritoneal dialysis (PD) catheter with simultaneously performed partial omentectomy and omentopexy. STUDY DESIGN: Pilot experimental study. ANIMALS: Beagle dogs (n = 6). METHODS: After placement of 1 sub-umbilical laparoscope portal and 1 instrument portal in the left cranial abdominal quadrant, laparoscopic-assisted partial omentectomy, and omentopexy were performed, and a modified Tenckhoff PD catheter was placed under laparoscopic guidance. A modified dialysis protocol was used twice daily for 4 days. The feasibility of the procedure, surgical duration, operative complications, and dialysis efficacy were evaluated. Postoperative pain and inflammation were graded (0-3). RESULTS: The procedure was successfully performed in all dogs with a median operating time of 25 minutes. No operative complications occurred. Procedure-related postoperative pain and inflammation were minimal. Eight consecutive PD procedures were successfully performed, and no leakage or obstruction was observed. CONCLUSIONS: Laparoscopic-assisted partial omentectomy and omentopexy can be performed at the same time as PD catheter placement with minimal morbidity.

Peritoneal dialysis in veterinary medicine.

Peritoneal dialysis is a modality of renal replacement therapy that is commonly used in human medicine for treatment of chronic kidney disease and end-stage kidney failure. Peritoneal dialysis uses the peritoneum as a membrane across which fluids and uremic solutes are exchanged. In this process, dialysate is instilled into the peritoneal cavity and, through the process of diffusion and osmosis, water, toxins, electrolytes, and other small molecules, are allowed to equilibrate.

A clinical review of peritoneal dialysis.

OBJECTIVE: To review the principles and practice of peritoneal dialysis in veterinary medicine. DATA SOURCES: Clinical and experimental studies and current guideline recommendations from the human literature; and original case studies, case reports, and previous reviews in the veterinary literature. SUMMARY: Peritoneal dialysis involves the exchange of solutes and fluid between the peritoneal capillary blood and the dialysis solution across the peritoneal membrane. It requires placement of a peritoneal dialysis catheter for repeated dialysate exchange. The ideal catheter provides reliable, rapid dialysate flow rates without leaks or infections. Catheter selection and placement are reviewed along with dialysate selection, exchange prescriptions, and overall patient management. PD does not require specific or complex equipment, and it can achieve effective control of uremia and electrolyte imbalances. CONCLUSIONS: Peritoneal dialysis is a potential life-saving measure for patients with acute renal failure. Peritoneal dialysis results in gradual decline in uremic toxins. Previously low success rates have been reported. Improved success rates have been noted in dogs with acute kidney injury (AKI) secondary to leptospirosis. Cats also have a good success rate when PD is elected in patients with a potentially reversible underlying disease. Overall, PD remains a viable intervention for patients with AKI unresponsive to medical management. In select patients a favorable outcome is attained whereby PD provides temporary support until return of effective renal function is attained.

Peritoneal dialysis in cats with acute kidney injury: 22 cases (2001-2006).

BACKGROUND: Peritoneal dialysis (PD) has been described for use in animals with acute kidney injury refractory to fluid therapy. However, no study has examined the use of PD in a large group of cats. HYPOTHESIS: PD is an important adjunctive therapy to treat acute kidney injury in cats. ANIMALS: The medical records of 22 cats with acute kidney injury that had received PD were examined. Animals were excluded if acute uremia was a result of postrenal causes such as uroabdomen or urethral obstruction. METHODS: Medical records were reviewed for the following: indication for PD, outcome, number of cycles performed, survival time, and predialysis and postdialysis results for blood urea nitrogen (BUN), creatinine, potassium, chloride, sodium, phosphorus, total protein, and albumin concentrations, and urine output. RESULTS: Indications for PD include acute-on-chronic kidney injury, acute kidney injury caused by toxins, bilateral ureteroliths, bilateral ureteral ligation as a complication of ovariohysterectomy, and unknown causes. The median survival time for all cats on PD was 4 days, although the median survival time for the cats that were discharged was 774 days. The most common complications were dialysate retention and sequestration of dialysate SC. There was a significant (P < .05) decrease between predialysis and postdialysis results for BUN, creatinine, potassium, phosphorus, total protein, and albumin concentrations. There was a significant (P < .05) difference in survival times between sexes. CONCLUSIONS AND CLINICAL IMPORTANCE: PD is an effective option for treatment of cats with acute kidney injury refractory to fluid therapy.

Management of acute renal failure in cats using peritoneal dialysis: a retrospective study of six cases (2003-2007).

Information regarding the use and success of peritoneal dialysis (PD) in the management of acute renal failure (ARF) in cats is lacking. The purpose of this retrospective study is to describe the indications, efficacy, complications and outcome of cats undergoing PD for ARF. Six cats that underwent PD for treatment of ARF of various etiologies were included. PD effectively replaced renal function in all cats and allowed renal recovery in 5/6 cats. Five cats were discharged and one cat died. Complications were reported in all cats and included subcutaneous edema (n=5), hyperglycemia (n=4), dialysate retention (n=3), and hypoalbuminemia (n=3). A novel technique consisting of a Blake surgical drain and an intermittent closed suction system was used, which appears to be a viable option for PD in cats. Although complications are common, PD is an effective renal replacement therapy for ARF in cats and carries a reasonable prognosis in selected cases.

Peritoneal dialysis in dogs and cats.

The peritoneal dialysis was carried out in dogs for the fist time in 1946. Since then, this method of therapy has been applied more and more frequently in veterinary medicine. The dialysis therapy is mainly recommended in the acute renal failure. Accordingly to the time period over which dialysis is performed and the flow pattern of the dialysate, different types of the peritoneal dialysis are distinguished. In carnivores, intermittent peritoneal dialysis is the most commonly applied method of dialysotherapy. However, despite a considerable effectiveness of this method, complications including uncontrolled transportation of elements and proteins or problems with catheter occur quite often. This article describes indications and contraindications which enable to qualify animal patients for dialysotherapy, and detailed principles of peritoneal dialysis procedure.

Strategies for management of acute renal failure.

Acute renal failure (ARF) is often defined as the sudden inability of the kidneys to regulate water and solute balance. ARF may be more broadly defined as rapid deterioration of renal function resulting in the accumulation of nitrogenous wastes such as urea and creatinine. Clinically, oliguria is defined as urine flow of less than 2 mL/kg/h and anuria has no measurable urine production. In animals, the most common cause of ARF is nephrotoxicity; ischemia ranks second, with interstitial and glomerular diseases following.

Peritoneal dialysis in emergency and critical care medicine.

Peritoneal dialysis is a technique that has been used to treat acute renal failure in humans since 1923. Peritoneal dialysis is used in people to manage acute and chronic renal failure, as well as to remove dialyzable toxins (ethylene glycol, barbiturates, and ethanol), reduce severe metabolic disturbances, and for the treatment of peritonitis, pancreatitis, uroabdomen, hypothermia, and fluid overload. In veterinary medicine, acute renal failure is the prevailing indication for dialysis. This report will discuss the pathophysiology of peritoneal dialysis, indications, and contraindications. Catheter selection and placement will be reviewed. Types of dialysate solution will be discussed and the protocol established for instituting peritoneal dialysis. The report will conclude with a discussion of potential complications and methods to minimize them.

Uroperitoneum in cats: 26 cases (1986-1995).

Uroperitoneum (UP) was diagnosed in 26 cats. Trauma was the most common cause (84.6%), including blunt abdominal trauma (59.1%), urethral catheterization (31.8%), and bladder expression (9.1%). The bladder was the most frequent site of urine leakage following blunt abdominal trauma (84.6%), while the urethra was the most common site following catheterization (71.4%). Common historical complaints were anuria (53.8%) and vomiting (50%). On physical examination, the bladders were palpable in nine (69%) of 13 cases; four of the nine had ruptured bladders. The ability to urinate did not exclude a diagnosis of UP since four noncatheterized cases reportedly urinated. Twenty-five cases were azotemic on presentation. The creatinine or potassium (K+) concentration in the serum compared to that in the peritoneal effusion (mean ratio, 1:2 and 1:1.9, respectively) was a useful indicator for UP. When performed, positive contrast radiography was diagnostic. Drainage of urine from the peritoneal cavity appeared to improve patient stabilization. Morbidity and mortality depended largely on the severity of associated injuries.

Peritoneal dialysis using a recycling system in dogs.

In this study, Recirculation Peritoneal Dialysis (RPD) apparatus using a pump to circulate the dialysate was devised and its dialysis efficiency was investigated. In the experiment, 15 mongrel dogs with body weights of 6.6 +/- 0.7 kg were used. The surgery to induce azotemia was performed on the dogs, a disk catheter for drainage was placed between the liver and diaphragm, and a straight catheter for infusion was placed on the abdominal side of the bladder. RPD was conducted using 2 l of dialysate containing 1.3% glucose, and the dialysate was circulated by a pump through the peritoneal cavity and the dialysate chamber at the circulation rates of 30, 60, 90 and 120 ml/min. RPD was conducted for 3 hr and the clearances of urea nitrogen, creatinine, inorganic phosphorus and potassium were recorded every hour. The clearances in RPD became higher with an increase in the circulation rate. Although RPD requires two catheters in the peritoneal cavity, it has no appreciable technical difficulty in handling and is considered to be easier than hemodialysis. RPD enabled higher dialysis efficiency to be achieved in a short time compared with conventional peritoneal dialysis. It seems reasonable to conclude that RPD is a useful new dialysis technique for animals.

Hemolytic uremic syndrome in dogs.

A disease syndrome similar to the hemolytic uremic syndrome of people is described in three dogs with acute renal failure. In each dog, hemorrhagic gastroenteritis preceded the onset of anuric acute renal failure. Evidence of microangiopathic hemolytic anemia (schizocytes, thrombocytopenia, and increased concentrations of fibrin split products) was present in the three dogs. Serum chemistry results showed increased concentrations of blood urea nitrogen, creatinine, and phosphorus. Ultrasound examination performed in one dog revealed increased echogenicity of the renal cortices. Treatment for anuric acute renal failure using a continuous dopamine and furosemide infusion established urine production in one of three dogs. Microscopic examination of tissue from the two dogs that underwent necropsy showed occlusion of the renal vasculature by fibrin thrombi consistent with microangiopathic arteriolar thrombosis. The pathophysiology and current knowledge of human hemolytic uremic syndrome is compared with hemolytic uremic syndrome in these dogs.

Peritoneal dialysis in dogs and cats: 27 cases (1976-1987).

The records of 25 dogs and 2 cats treated with peritoneal dialysis during an 11-year period were evaluated. The indications for peritoneal dialysis were acute renal failure in 21 animals, chronic renal failure in 5 animals, and azotemia of undetermined cause in 1 animal. Peritoneal dialysis resulted in a significant (P less than 0.05) decrease in serum urea nitrogen concentration in 19 of the dogs and a significant (P less than 0.05) decrease in serum creatinine in 20 dogs. The most common complication of peritoneal dialysis was hypoalbuminemia (11 animals affected). Other common complications were dialysate retention/catheter obstruction (8 animals), peritonitis (6 animals), hypochloremia (6 animals), and subcutaneous leakage of dialysate (6 animals). Twelve dogs and 2 cats died during treatment, 6 dogs were euthanatized, and 1 dog was lost to follow-up evaluation. The remaining 6 dogs survived and were discharged from the hospital after successful peritoneal dialysis. On the basis of the results of this study, the authors concluded that peritoneal dialysis, although associated with a high complication rate, was a successful technique for reducing azotemia in dogs with acute and chronic renal failure. Survival rates were poor because of the severity of the underlying renal diseases.

Acute renal failure as a complication in the critically ill animal.

Acute renal failure is associated with a high morbidity and mortality in the intensive care animal. The two most common causes are ischemic/reperfusion injury and insult from nephrotoxins. Damage to the renal cells (e.g., endothelial, tubular, or mesangial cells) and altered hemodynamics result in reduced glomerular blood flow, tubular backleak, tubular obstruction, and/or decreased glomerular permeability. Recognition of ARF during the initiation stage provides the optimal chance for recovery. Adequate circulatory blood volume and systemic blood pressure must be established prior to pharmacologic intervention. Once ARF is in the maintenance phase, metabolic consequences of uremia must be managed.

Reversal of ethylene glycol-induced nephrotoxicosis in a dog.

Ethylene glycol-induced nephrotoxicosis was diagnosed in a dog with acute renal failure. Histologically, the dog had proximal tubular degeneration and necrosis, intraluminal calcium oxalate crystals, generally intact tubular basement membranes, and evidence of tubular regeneration. After 20 days of peritoneal dialysis and diuresis, renal function was adequate to maintain homeostasis without supportive care. Nine weeks after onset of the ethylene glycol-induced renal failure, the dog's kidneys were histologically and functionally normal.