Hemodialysis in dogs

Dr. Randhir Singh
Hemodialysis is a method of blood purification that removes blood from the body through a catheter and filters it through a dialyzer (artificial kidney). It is used to purify by eliminating toxic metabolites, balancing electrolytes and removing excess fluid that builds up in body when the kidneys are unable to excrete it. Common indications of hemodialysis include oliguria/ anuria of acute kidney injury (AKI), azotemia due to chronic kidney disease (CKD) and AKI, intoxications, fluid overload, hyperkalemia and acidosis, which are refractory to conventional therapy.
In recent years, there is an abrupt increase in dogs presented to veterinarians with renal failure. In the authors’ parent institute, on an average, 4-5 dogs are daily presented in medicine OPD which are diagnosed with renal failure and 2-3 such dogs are suitable candidates for undergoing dialysis.
What is renal failure in dogs?
Renal failure (also termed to as kidney failure) can be caused by numerous conditions that negatively affect the functioning of the kidneys and its related organs. A healthy dog’s kidneys work to regulate hydration, release hormones required to produce red blood cells, remove toxins and maintain a normal balance of electrolytes. If a dog experiences renal failure, the kidneys no longer perform these functions efficiently. While kidney problems can be concerning for any pet parent, don’t lose hope if your veterinarian has diagnosed your dog with a kidney issue that may lead to kidney failure. Depending on the circumstances, there may be measures you and your veterinarian can take to prolong your pet’s life. Here’s what you should know as pet parent:
There are two types of renal failure in dogs:
Acute Kidney Injury (AKI)
Most commonly associated with toxins or infections, acute renal failure causes kidney function to suddenly decline (in hours or days).
Chronic Kidney Disease (CKD)
This type of kidney failure involves more gradual loss of kidney function (over weeks, months or years). Degeneration associated with geriatric decline is often to blame. While all kidneys have a natural lifespan, some dogs’ kidneys will, unfortunately, deteriorate more quickly than others.
Causes of Kidney Failure
Any disease that impacts the kidneys can cause kidney failure. These conditions include geriatric degeneration, congenital diseases, various diseases (tick fever, leptospirosis), toxicosis (chocolate or antifreeze) or drugs (such as ibuprofen or acetaminophen), dehydration, acute blood loss and many more. Some dog breeds are genetically predisposed to renal failure which include Samoyed, Bernese mountain dog, Bull Terrier, Cairn Terrier, English Cocker Spaniel, and German Shepherd.
Treatment for Renal Failure in Dogs
Severity of symptoms will determine appropriate treatments, which may include IV fluids, though if the disease is extremely severe your pooch may not respond to treatment. Aggressive treatments may include hospitalization for fluid therapy, dialysis or a kidney transplant. Always keep in mind that CKD cannot be cured but it can be well managed to prolong your pooch’s life. Prognosis is associated with severity of disease. As your dog progresses through stages of renal disease, survival time is likely to grow shorter. Your vet may also suggest changes in diet to improve your pet’s quality of life and potentially limit the progression of disease, leading to a longer lifespan.
Dialysis as a treatment modality
Hemodialysis in pets suffering from renal failure is a ‘high tech’ Veterinary specialty which has saved lives of many pets. World over, there are only 8-10 veterinary institutes which specialize in hemodialysis techniques and only two in India one being in Madras Veterinary College, Chennai and other in India’s premier Veterinary institute, Guru Angad Dev Veterinary & Animal Sciences University (GADVASU), Ludhiana, Punjab.
Frequently asked questions from pet owners:
Q. Is dialysis painful and require my pet to be anesthetized or sedated?
A. Actually, pet patients tolerate hemodialysis incredibly well even without sedation. Only aggressive pets require sedation and dialysis procedure as a whole is relatively painless.
Q. Will dialysis cure my pet’s damaged kidneys?
A. No, dialysis does not ‘fix’ the damaged kidneys. Dialysis provides supportive care, taking the place of kidney until kidney function returns.
Q. How many dialysis sessions will my pet require?
A. The number of sessions will vary depending on the underlying disease condition and extent of kidney injury. Initially, 3 dialysis sessions on alternate days are performed.
Q. How long dialysis session last?
A. A session usually lasts 4-5 hours in length.
General referral guidelines for field Veterinarians/ Private Practitioners
* Early referrals will allow for assessment of patient’s candidacy.
* Avoid using the jugular veins in any potential candidate for hemodialysis. Due to size of our patients, the jugular veins are used for vascular access and must be protected in any patient where dialysis is an option i.e. preferentially sample from peripheral sites like cephalic/ sephenous veins.
* Dialysis is a huge financial and emotional investment for all involved and therefore careful discussion and counseling with the clients will take place before we agree to proceed with dialysis.
Dialysis is fixed only after complete patient evaluation which generally take one whole day.
Prepare and counsel clients to arrange another dog to act as blood donor as many a time dogs requiring dialysis suffer from anemia and require urgent blood transfusion.
The author is Assistant Professor (Veterinary Medicine) Department of Teaching Veterinary Clinical Complex (TVCC) Guru Angad Dev Veterinary & Animal Sciences University (GADCASU) Ludhiana, Punjab.