Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Continuous Renal Replacement Therapy of Chronic Kidney Disease with Uncontrolled Azotemia in Six Dogs

개선되지 않는 질소혈증 동반한 만성신부전 환자에서 지속적 신대체 요법의 적용

  • Han, Sei-Myoung (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University) ;
  • Kim, Jong-Taek (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University) ;
  • Lee, Jong-Bok (Oraeorae Animal Hospital) ;
  • Seo, Kyoung-Won (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University) ;
  • Song, Woo-Jin (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University) ;
  • Ryu, Min-Ok (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University) ;
  • Hwang, Cheol-Yong (The Research Institute for Veterinary Science, College of Veterinary Medicine, Seoul National University) ;
  • Youn, Hwa-Young (Department of Veterinary Internal Medicine, College of Veterinary Medicine, Seoul National University)
  • 한세명 (서울대학교 수의과대학 수의내과학교실) ;
  • 김종택 (서울대학교 수의과대학 수의내과학교실) ;
  • 이종복 (오래오래 동물병원) ;
  • 서경원 (충남대학교 수의과대학 수의내과학교실) ;
  • 송우진 (서울대학교 수의과대학 수의내과학교실) ;
  • 유민옥 (서울대학교 수의과대학 수의내과학교실) ;
  • 황철용 (서울대학교 수의과학 연구소) ;
  • 윤화영 (서울대학교 수의과대학 수의내과학교실)
  • Accepted : 2015.10.17
  • Published : 2015.10.30
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Abstract

The purpose of this case report was to present the treatment of continuous renal replacement therapy (CRRT) in dogs with end-stage CKD with uncontrolled uremia. Hemodialysis were carried out 6 patients who failed to improve clinical status with conventional management for CKD. Four dogs with urea reduction ratio (URR) range of 57-72% and 1 dog with URR of 37.3% showed good outcome with decreasing tendency of pre-dialysis Therefore, we suggest that CRRT could be recommended for use in CKD dogs with uncontrolled azotemia or uremia and should be monitor carefully throughout the CRRT.

본 케이스는 요독증이 해소되지 않는 말기 만성 신부전 환자에서의 지속적 신대체요법에 관한 보고이다. 본 원에 내원하여 만성신부전으로 진단 내려진 6마리의 환자에서 수액요법과 같은 일반적인 대증요법에 개선이 없었다. 따라서 혈액투석방법을 진행하였다. 평균 57-72%의 요소감소율을 보인 4마리의 환자와 37.3%의 요소감소율을 보인 1마리의 환자견에서 좋은 개선을 보였다. 하지만 6마리의 환자견에서의 93회 혈액투석 동안 체외흐름 폐색, 항응고제 사용에 의한 과도한 출혈등과 같은 부작용이 12회 발생하였다. 따라서 요독증이 개선되지 않는 만성 신부전 환자에서의 지속적 신대체요법은 유용하다 할 수 있으며 혈액투석동안 면밀한 부작용 관찰이 중요하다 여겨진다.

Keywords

References

  1. Acierno MJ. Continuous renal replacement therapy in dogs and cats. Vet Clin North Am Small Anim Pract 2011; 41: 135-146. https://doi.org/10.1016/j.cvsm.2010.09.001
  2. Bellomo R, Farmer M, Parkin G, Wright C, Boyce N. Severe acute renal failure: A comparison of acute continuous hemodiafiltration and conventional dialytic therapy. Nephron 1995; 71: 59-64. https://doi.org/10.1159/000188675
  3. Clark WR, Mueller BA, Alaka KJ, Macias WL. A comparison of metabolic control by continuous and intermittent therapies in acute renal failure. J Am Soc Nephrol 1994; 4: 1413-20.
  4. Cowgill LD. Urea kinetics and intermittent dialysis prescription in small animals. Vet Clin North Am Small Anim Pract 2011; 41: 193-225. https://doi.org/10.1016/j.cvsm.2010.12.002
  5. Cowgill LD, Langston CE. Role of hemodialysis in the management of dogs and cats with renal failure. Vet Clin North Am Small Anim Pract 1996; 26: 1347-1378. https://doi.org/10.1016/S0195-5616(96)50132-4
  6. Diehl SH, Seshadri R. Use of continuous renal replacement therapy for treatment of dogs and cats with acute or acuteon-chronic renal failure: 33 cases (2002-2006). J Vet Emerg Crit Care 2008; 18: 370-382. https://doi.org/10.1111/j.1476-4431.2008.00323.x
  7. Finkel KW, Podoll AS. Complications of continuous renal replacement therapy. Semin Dial 2009; 22: 155-159. https://doi.org/10.1111/j.1525-139X.2008.00550.x
  8. Fischer JR, Pantaleo V, Francey T, Cowgill LD. Veterinary hemodialysis: advances in management and technology. Vet Clin North Am Small Anim Pract 2004; 34: 935-967. https://doi.org/10.1016/j.cvsm.2004.03.007
  9. Owen Jr WF, Lew NL, Liu Y, Lowrie EG, Lazarus JM. The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis. N Engl J Med 1993; 329: 1001-1006. https://doi.org/10.1056/NEJM199309303291404
  10. Ross S. Anticoagulation in intermittent hemodialysis: pathways, protocols, and pitfalls. Vet Clin North Am Small Anim Pract 2011; 41: 163-175. https://doi.org/10.1016/j.cvsm.2010.12.001
  11. Shimokawa MT, Yoshioka C, Minami K, Okawa T, Hiraoka H, Itamoto K, Mizuno T, Okuda M. Nafamostat mesilate is not appropriate as an anticoagulant during continuous renal replacement therapy in dogs. J Vet Med Sci 2010; 72: 363-367. https://doi.org/10.1292/jvms.09-0369
  12. Uchino S, Bellomo R, Ronco C. Intermittent versus continuous renal replacement therapy in the ICU: impact on electrolyte and acid-base balance. Intensive Care Med 2001; 27: 1037-1043. https://doi.org/10.1007/s001340100953