Renal Replacement Therapy in Healthy Adult Horses

Abstract

Background: Renal replacement therapy (RRT) has been implemented extensively in people to facilitate recovery from acute renal failure (ARF). RRT has not been explored in horses, but might provide a further treatment option in horses with ARF.Objective: To investigate efficacy and safety of RRT in horses. Animals: Five healthy adult horses. Methods: A prospective study was performed on horses restrained in stocks and intravenously connected to a commercial RRT machine to allow continuous venovenous hemodiafiltration to be performed for 6 hours. The RRT machine was set at the following flow rates: blood flow rate 250 mL/min; dialysate rate 3,000 mL/h; prefilter replacement pump 3,000 mL/h; and postfilter replacement pump rate 2,000 mL/h. Balanced electrolyte solution was used as dialysate and replacement fluid. Heart rate, respiratory rate, body temperature, direct arterial blood pressure, urine output, and various clinicopathologic parameters were measured over the study period.Results: Renal replacement therapy was successfully performed in horses, resulting in a mean creatinine clearance of 0.127 mL/kg/min (68.9 mL/min) and urea reduction ratio of 24%. No adverse effects were detected although a significant decrease in rectal temperature was observed (P .007). A significant increase in serum phosphorus (P .001) and decrease in BUN (P < .001) were also noted. A significant prolongation of prothrombin (P < .01) and partial thromboplastin time (P < .0001) were observed along with a decrease in platelet count (P .04). Conclusions and Clinical Importance: Renal replacement therapy can safely and effectively be used in adult horses.

Acute kidney injury due to Leptospira interrogans in 4 foals and use of renal replacement therapy with intermittent hemodiafiltration in 1 foal

“…Hemodiafiltration treatment has been documented in a foal with post‐resuscitation renal failure and in healthy adult horses using a continuous RRT machine . Both reports describe successful treatment without major adverse effects in the patients . Hemodiafiltration is a well‐established treatment in dogs, and monitoring protocols used for dogs performed very well for this foal, including regional citrate anticoagulation.…”

“…11 Both reports describe successful treatment without major adverse effects in the patients. 10,11 Hemodiafiltration is a well-established treatment in dogs, and monitoring protocols used for dogs performed very well for this foal, including regional citrate anticoagulation. The main difficulty would have been if further treatment was required, because of development of thrombophlebitis and the necessity to keep a patent large-bore dialysis catheter for the duration of dialysis support.…”

“…Renal replacement therapy (RRT) is recommended in dogs with the severe renal form of leptospirosis . Indications to perform RRT include “oliguria or anuria with subsequent life‐threatening hyperkalemia or severe volume overload and advanced uremia refractory to medical management.” Renal replacement therapy is not considered a routine treatment for foals with acute kidney injury and specific recommendations for its use in horses are not available because of the low number of documented cases . Hemodiafiltration (HDF) has been described in adult horses and in 1 foal with post‐resuscitation acute renal failure, whereas hemodialysis has only once been reported as treatment for oxytetracycline‐induced acute renal failure in a foal .…”

“…8 Renal replacement therapy is not considered a routine treatment for foals with acute kidney injury and specific recommendations for its use in horses are not available because of the low number of documented cases. [9][10][11][12][13][14][15] Hemodiafiltration (HDF) has been described in adult horses 11 and in 1 foal with post-resuscitation acute renal failure, 10 whereas hemodialysis has only once been reported as treatment for oxytetracycline-induced acute renal failure in a foal. 9 The latter foal was treated under general anesthesia on 3 occasions over a 4-day period.…”

Intermittent Hemodialysis, an Alternative Treatment for Ovine With Acute-on-Chronic Kidney Disease.

“…Acute Renal Injury has multiple pathophysiology mechanisms such as renal infarction and ischemia by hypovolemia, myoglobinuria, hemoglobinuria, leptospirosis and other infectious diseases, vasculitis, neoplasia, urolithiasis, and toxic nephropathies by aminoglycosides, non-steroidal antiinflammatory drugs (NSAIDs), heavy metals, vitamin D toxicosis and many other exogenous and endogenous insults (4,(10)(11)(12). Although urolithiasis is common in sheep, cases of AKI are unusual.…”