Dialysis to Treat Kidney Failure

Sometimes horses in renal (kidney) failure don't respond to conventional treatment--fluids, diuretics, etc. Toxins in the blood irritate the stomach, making the horse anorexic and depressed. At that point, dialysis might be the only option. The peritoneum, or lining between the abdomen and body wall, acts like a natural dialysis membrane in horses, letting toxic substances exit the blood while nutrients remain. Because the equine abdomen is so large, it provides a huge surface area for filtration.

Recently, Laurie Gallatin, DVM, Dipl. ACVIM; fellow researchers from the Purdue University School of Veterinary Medicine; and personnel from the Arnett Clinic, Greater Lafayette Health Services, and HemoCleanse in West Lafayette, Ind., reported on a case of acute renal failure in a Paso Fino gelding and the use of continuous-flow peritoneal dialysis, an alternative form of the dialysis technique.

For three days, the gelding had been treated with fluids and diuretics, but responded only minimally. After referral to Purdue, he was found to have a marked concentration of blood urea nitrogen (BUN) and creatinine, a toxic condition called azotemia. The horse was depressed and anorexic. After the third day of conventional treatment without significant improvement, the decision was made to begin peritoneal dialysis on an intermittent basis.

Ten to 15 liters of fluids were placed into the gelding's abdomen through a catheter. The horse was walked, then the fluid was allowed to drain. However, after six days of treatment, the horse remained azotemic and anorexic. Gallatin describes this as the point of treatment failure. "The intermittent peritoneal dialysis was not bringing the BUN and creatinine in the blood back to normal levels," she explains. "The horse was also not eating well and not showing any clinical improvement."

At that point, it was decided to try continuous-flow peritoneal dialysis (CFPD), which provides a continuous inflow of fluid into the abdomen and a continuously open outflow catheter attached to a closed collection bag. This was the first time the technique was attempted in an adult horse with renal failure. "The options were very limited," says Gallatin, "but the owner was not willing to give up yet."

The CFPD equipment was in place for 72 hours, and the gelding slowly improved. At discharge, BUN and serum creatinine were greatly reduced from day of admission, and by three months after discharge, both parameters were within normal limits.

While CFPD is labor-intensive and quite expensive, the results of this case show that it might be useful as another approach for horses in renal failure that do not respond to traditional therapies.

Gallatin, L.L.; Couetil, L.L.; Ash, S.R. Journal of the American Veterinary Medical Association, 226(5): 756-759, 2005.

About the Author

Susan Piscopo, DVM, PhD

Susan Piscopo, DVM, PhD, is a free-lance writer in the biomedical sciences. She practiced veterinary medicine in North Carolina before accepting a fellowship to pursue a PhD in physiology at North Carolina State University. She lives in northern New Jersey with her husband and two sons.

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