Peritoneal dialysis (PD) is most frequently used in the management of acute kidney injury (AKI) refractory to fluid therapy. The purpose of this study is to examine indications, effectiveness, outcomes and complications associated with the use of PD in cats with AKI.
A database search of all cats receiving PD for AKI at Tufts University Cummings School of Veterinary Medicine from 2001-2006 was performed. The following data was collected from the 22 cats who qualified: signalment, weight, indication for PD, number of PD cycles, number of days of PD, outcome (discharge, euthanasia or death), days from the start of PD to endpoint (discharge vs. euthanasia or death), mean survival time (MST) from onset of PD, and method of catheter placement (surgical placement with omentectomy vs. non-surgical placement). Complications were recorded from each patient's daily record. Pre- and post-PD values were obtained for the following variables: blood urea nitrogen, creatinine, phosphorus, sodium, potassium, chloride, total protein, albumin, and urine output.
Indications for PD consisted of acute-on-chronic renal failure (7/22), urolithiasis (5/22), nephrotoxins (4/22), spay complications (3/22), unknown reasons (3/22). 45.5% of cats were discharged from the hospital after PD. 31.8% of cats were euthanized before discharge from the hospital. 22.7% of cats died in the hospital while receiving PD. There was a significant difference (p=0.034) in MST depending on the indication for PD. 100% (3/3) of cats with spay complications were discharged from the hospital. The MST for these cats from onset of PD was 1423 days (984-1867). 60% (3/5) of cats with urolithiasis-induced AKI were discharged from the hospital. The MST for this group was 332.6 (0-866). 42.8% (3/7) of cats with acute-on-chronic renal failure were discharged from the hospital. The MST for this group was 175.7 days (0-839). Of cats presenting with toxicities, there were no survivors (0%, 0/4). The MST for cats with toxicity was 2.5 days (1-4).
Common complications of PD included dialysate retention and sequestration of dialysate under the skin. Less common complications included clogged PD catheters, leakage of fluid from catheter sites, painful abdomen, peritonitis, dehiscence of surgical incision and pleural effusion. Hypoproteinemia and hypoalbuminemia were the most common bloodwork abnormalities noted. Technical complications were present in both methods of placement of PD catheters, but the complication rate was lower in cats with surgically placed PD catheters with partial omentectomy compared to ER placement of catheters.
PD is an important therapeutic tool for reducing uremia and giving kidneys time to recover in cats with AKI when conventional therapy is no longer effective.