NU11 - Continuous Renal Replacement Therapy in Dogs with Acute Kidney Injury: Dose Prescription and Adequacy Assessment

Abstract: Background- Continuous renal replacement therapy (CRRT) is increasingly used for the management of dogs with acute kidney injury.

Objectives- To describe the management of dogs with AKI by CRRT, and to investigate the relationship between a prescribed CRRT target dose and the hourly urea reduction ratio.

Animals- Forty-five client-owned dogs diagnosed with severe AKI, receiving 48 CRRT treatments at a veterinary teaching hospital.

Methods- Retrospective study. Search of medical records of dogs with AKI managed by CRRT.

Results- Median serum urea and creatinine at CRRT initiation were 252 mg/dL (range, 64-603 mg/dL) and 9.0 mg/dL (range, 4.3-42.2 mg/dL), respectively. Median treatment duration was 21 hours (range, 3-32). Systemic heparinization and regional citrate anticoagulation were used in twenty-four treatments each (50%). The median CRRT target dose for the entire treatment was 1 ml/kg/min (range, 0.3-2.5 ml/kg/min). Urea reduction ratio (URR) for the entire treatment was 76% (range, 11-92%) and the median hourly URR was 4%. While CRRT dose was increased gradually from 0.9 ml/kg/min to 1.4 ml/kg/min (P < 0.001) the hourly URR decreased from 6.5% to 5.5% (P = 0.05). The main complication was clotting of the extra-corporeal circuit, occurring in 6/48 treatments (13%).

Conclusions and clinical importance- CRRT is a safe treatment modality for dogs with AKI, when the prescribed dose is based on the current veterinary guidelines for intermittent hemodialysis and human practice guidelines for CRRT. Treatment adequacy was maintained by gradually increasing the dose according to the actual URR.