Complications Of Hemodialysis

Dialysis in Horses

Your horse suffered a severe tying-up episode, and due to accompanying muscle degeneration your horse now has renal (kidney) complications. Or maybe your horse is experiencing renal dysfunction due to a toxic reaction to medications or from a massive infection. Your veterinarian administered the usual treatments to clear the toxins, but the kidney values remain dangerously high, indicating the kidneys are still unhealthy. Is there anything more you can do to save your horse?

In acute cases such as these, dialysis might succeed where other measures have failed. While it's an expensive procedure that rivals the cost of some colic and complicated orthopedic surgeries, and is yet not widely offered, it is an option.

Dialysis Defined

"The purpose of dialysis is to remove the waste products that build up in the body and, in that respect, temporarily replace the kidney function," explained Laurent Couetil, DVM, PhD, Dipl. ACVIM, professor of large animal medicine and equine sports medicine director at Purdue University.

There are three different dialysis procedures: hemodialysis, peritoneal dialysis, and pleural dialysis.

With hemodialysis , a procedure commonly used in humans, the veterinarian places an intravenous (IV) catheter; blood is collected and transferred to a machine that filters toxins from the blood, and the filtered blood is returned to the patient through another vein.

"Hemodialysis has been described in a foal and the technique has also been recently reported in healthy adult horses," Couetil noted. "It's very involved, very cumbersome. The equipment is very expensive, the procedure is technically complex, and there are more potential complications with hemodialysis such as clotting problems because the blood comes in contact with nonbiologic membranes during the process."

Harold C. Schott II, DVM, PhD, Dipl. ACVIM, professor of large animal clinical sciences at Michigan State University's Veterinary Medical Center, added, "A few veterinary schools offer hemodialysis, but only for dogs and cats."

Intermittent peritoneal dialysis is the most commonly used form of dialysis in horses (such as in foals with bladder rupture) to stabilize them prior to surgery. With this procedure, the veterinarian places a catheter through the abdominal wall, then injects dialysate (a blood-cleansing solution) into the peritoneal membrane (lining of the inside of the abdomen), explained Couetil. While in the peritoneal cavity, the dialysate extracts toxins and excess fluid from the blood.

Ten Long Term Complications of Hemodialysis

Hemodialysis is one of the processes utilized to remove waste products and excess fluids from the blood with the use of a dialyzer (aritificial kidney). This procedure is prescribed to patients diagnosed with chronic kidney disease (CKD) or end-stage renal disease (ESRD) because their damaged kidneys are no longer capable of removing excess toxin and water from the body.

Hemodialysis can extend the life span of an ESRD patient, though this is not without complication. Unfortunately, there are unwanted long term complications brought about by this treatment. Listed below are the ten long term complications of hemodialysis.

1.   Anemia

One of the functions of a kidney is the production of erythropoietin. A person diagnosed with ESRD or CKD has a reduced production of erythropoietin. Erythropoietin is a hormone produced by the kidneys to stimulate the bone marrow to produce red blood cells. The average hemoglobin level of a healthy person is 14-18 gm/dl for adult males and 12-16 gm/dl for adult women.

A person undergoing dialysis has an average hemoglobin level of 7gm/dl without epoeitin injections. Anemia can be further aggravated by the chronic blood loss associated with dialysis procedure and frequent blood sample testing.

2.  Renal Osteodystrophy

Renal osteodystrophy is usually associated with people with kidney disease. In fact this bone disease, affects nearly 90% of patients in dialysis. This occurs when kidneys fail to maintain the proper ratio of calcium and phosphorus in the blood. The most common complaints are sore painful feet, joint and bone pain.

3.  Malnutrition

Malnutrition is common among hemodialysis patients due to the strict nutritional requirements imposed on a patient. Their dietary modification is complex and difficult to adhere to. Nutritional consult is very important to find the balance between nutritional needs of the body. Disease progression of the patient should always be taken into consideration.

4.  Hepatitis

Hepatitis is an indication of an inflamed liver. There are several hepatitis virus strains namely; types A, B, C, D, E, F (not confirmed), and G. Patients who undergo hemodialysis are at greater risk of getting infected with viral hepatitis because of the blood borne organisms that can be transmitted by poor aseptic practices of medical health workers. The risk of getting infected with the virus, fortunately, has gone down due to strict monitoring and safety rules dictated by the Health Department.

Handbook of dialysis

Complications of dialysis

Dialysis - Principle, Advantages and Disadvantages

Clinical dialysis

Replacement of renal function by dialysis