Kisállatok hemodialízis-kezelése

Abstract

ÖSSZEFOGLALÁS A szerzők irodalmi összefoglalójukban kisállatok hemodialízis-kezelésének indikációit, típusait, gyakorlati kivitelezését, valamint lehetséges eredményeit tekintik át. A hemodialízis egy testen kívüli művesekezelési mód, amelynek során a páciens vérét a szervezetből kivezetik, egy dializátoron keresztül megtisztítják, majd visszavezetik a páciensbe, így helyettesítve a vesék sokrétű feladatait. A hemodialízis alkalmas az uraemiás toxinok mennyiségének csökkentésére, a metabolit- és elektrolitegyensúly rendezésére, továbbá bizonyos toxinok szervezetből való eltávolítására is. SUMMARY In their literature review, the authors summarize the principles, indications, practical approaches, and possible outcomes of hemodialysis treatment in companion animals. Hemodialysis is an extracorporeal renal replacement therapy, in which the patient’s blood is removed from the body, typically via a jugular catheter, cleaned through a dialyser, and then returned to the patient, thus replacing the multiple functions of the kidneys. The adequate dual-lumen catheter choice and appropriate anticoagulation (with heparin or citrate) are essential. In veterinary medicine, the most common indications for hemodialysis are acute or acute-on-chronic kidney injury, which are non-responsive to medical management, and toxin ingestions. The major causes of acute kidney injury include toxin ingestions, hemodynamic instabilities (ischemia), immune-mediated diseases, infectious diseases, e.g. leptospirosis. With hemodialysis, we can ameliorate the clinical consequences of uraemia and intoxications by removing ingested toxins (e.g. ethylene glycol) and uraemic toxins, correcting electrolyte and acid-base imbalances, and removing fluid overload. The two modalities used in veterinary medicine for hemodialysis are intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT). Hemoperfusion (HP) and therapeutic plasma exchange (TPE) are advanced modalities, and their availability for small animals is still limited. Hemodialysis does not cure or repair the damaged kidneys; however, it can replace many functions of the kidneys, so the patient can survive the critical time during acute kidney injury. For those patients that do not respond to conservative management of acute kidney injury, hemodialysis is the last choice of treatment. Recently, hemodialysis is a feasible, safe, and often life-saving choice to treat acute kidney injury in companion animals.