RU2765741C1 - METHOD FOR HEMODIALYSIS IN DOGS WEIGHING 8 kg OR MORE - Google Patents

Abstract

FIELD: veterinary medicine.

SUBSTANCE: invention relates to veterinary medicine and can be used for hemodialysis in dogs weighing 8 kg or more. The method includes hemocorrection and detoxification of the blood the animal by means of an extracorporeal contour. In dogs, only the jugular vein is punctured once with a dual-lumen catheter, the extracorporeal contour is filled at 115 to 200 ml, and blood perfusion is executed via the blood line at a rate of 7 to 9 ml/min per kg weight of the animal. Upon the end of the procedure, heparinised saline solution is injected into the lumen of the catheter as a "heparin lock", after 3 to 5 days, the procedure is repeated under control of biochemical parameters 2 to 4 times until homeostasis is normalised.

EFFECT: use of the invention provides a possibility of reducing the amount of puncturable blood vessels to one and the risk of possible complications (bleeding, infection, thrombosis), conducting hemodialysis in an animal weighing more than 8 kg, increasing the rate of blood perfusion to 7-9 ml/min per kg weight, and increasing the volume of the extracorporeal contour to 115-200 ml, reducing the time of the procedure, increasing the effectiveness of treatment, conducting subsequent procedures without repeated puncturing of the vascular bed.

1 cl, 8 tbl, 2 ex

Description

The present invention relates to veterinary medicine and is intended for extracorporeal hemocorrection and detoxification of animals with chronic and acute renal failure. Kidney failure is a formidable and widespread condition that occurs in pets (1). This disturbance of homeostasis occurs in a wide range of diseases and is characterized by a progressive and irreversible decrease in the number of functioning kidney nephrons, which leads to the accumulation of toxins in the blood of the animal (2). The high prevalence of chronic insufficiency in domestic animals requires the search for ways to correct this condition.

Among the available methods of hemocorrection and detoxification, extracorporeal hemodialysis is the most modern and effective (3). In clinical practice, as a rule, a number of consecutive hemodialysis sessions are required to compensate for renal failure.

As the closest analogue, the “Method for carrying out hemodialysis in pet cats and dogs” is adopted, in which a sick cat or dog weighing up to 8 kg is connected to the extracorporeal circuit and the purified blood is sent through the blood duct of the extracorporeal circuit to the dialyzer and then, after passing through the dialyzer, the purified blood is returned animal along the blood line. At the same time, the rate of blood perfusion during the hemodialysis procedure is 1.5-6.0 ml per minute per kilogram of animal weight, and the filling volume of the extracorporeal circuit is from 14 to 50 ml, depending on the weight of the animal undergoing hemodialysis. Patent RU 2 636 850 C2.

The disadvantages of this method are that the hemodialysis procedure involves puncturing 2 blood vessels, which increases the risk of possible complications during the administration of anticoagulants, there is a weight limit of the animal up to 8 kg, the filling volume of the extracorporeal circuit is fixed in the range of 14-50 ml and is also limited the rate of blood perfusion is 6 ml/min per kg; in addition, a single procedure does not always allow achieving normalization of the condition.

Objectives: to reduce the number of punctured blood vessels during surgery, reduce the risk of possible complications, enable hemodialysis for animals weighing more than 8 kg, increase the filling volume of the extracorporeal circuit, while increasing the rate of blood perfusion, increase the effect of treatment.

The essence of the invention is that in dogs with a double-lumen catheter, only the jugular vein is punctured once, the extracorporeal circuit is filled with 115-200 ml and blood is perfused through the blood line at a rate of 7-9 ml/min per kg of animal weight, at the end of the procedure into the lumen of the catheter heparinized physiological solution is administered as a "heparin lock", after 3-5 days the procedure is repeated under the control of biochemical parameters 2-4 times until homeostasis is normalized.

EFFECT: method allows to reduce the number of punctured blood vessels to one and the risk of possible complications (bleeding, infection, thrombosis), to perform hemodialysis for an animal weighing more than 8 kg, to increase the blood perfusion rate to 7-9 ml/min per kg of body weight and to increase the volume of extracorporeal contour up to 115-200 ml, reduce the time of the procedure, increase the effect of treatment, provide the possibility of subsequent procedures without repeated puncture of the vascular bed.

The method was tested on 16 animals in a state of renal insufficiency, each animal underwent 2 to 4 procedures. Laboratory markers of renal dysfunction were monitored, namely creatinine, urea, phosphorus, sodium, potassium, ph.

For a better understanding of the described method, tables 1-5 are shown containing the results of biochemical blood tests of the first animal and tables 6-8 with the results of the second animal.

Table 1. Biochemical analysis of blood taken before hemodialysis.

Table 2. Biochemical analysis of blood taken after the first procedure.

Table 3. Biochemical analysis of blood taken after the second procedure.

Table 4. Biochemical analysis of blood taken after the third procedure.

Table 5. Biochemical analysis of blood taken after the fourth procedure.

Table 6. Biochemical analysis of blood taken before hemodialysis.

Table 7. Biochemical analysis of blood taken after the first procedure.

Table 8. Biochemical analysis of blood taken after the second procedure.

The method is carried out as follows. In the conditions of the clinic's office, after antiseptic treatment, the jugular vein of the animal is punctured with a double-lumen catheter. The catheter is connected to a dialysis circuit with a volume greater than 115 ml. The parameters of the hemodialysis apparatus are set, based on the characteristics of the connected animal. Start the hemodialysis procedure. After the end of the procedure, the catheter is disconnected from the dialysis circuit. Blood is taken for biochemical analysis, according to the results, the following procedure is prescribed. Heparinized 0.9% NaCl is injected into the lumen of the catheter - a “heparin lock” is created.

For a better understanding of the method, we give clinical examples No. 1 and No. 2.

Example #1

Samoyed male. Ray, 2 years old, weight 18 kg, examined.

Diagnosis: acute renal failure on the background of babesiosis. Anuria. Severe condition, stupor, lying position.

The intervention was carried out in the conditions of the treatment room, after antiseptic treatment, the left jugular vein of the animal was punctured with a double-lumen Balton catheter (diameter 8F). The catheter was connected to a 115 ml dialysis circuit. The parameters of the Fresenius 4008n hemodialysis apparatus were set, based on the characteristics of the connected animal, namely, the temperature was 37.5°C, the perfusion rate was 7 ml/min per kg. Produced a hemodialysis procedure lasting 3 hours 24 minutes. Ultrafiltration 674 ml. After the end of the procedure, the catheter was disconnected from the dialysis circuit, a heparin one was installed by introducing 1.2 ml of a heparinized solution of 0.9% NaCl.

The period after the procedure was standard, without complications, the site of the catheter without visual signs of inflammation, bleeding, hematoma. Positive dynamics of diuresis: 1.5 ml/kg per minute. After the procedure, a biochemical blood test was taken.

To achieve the maximum effect, an additional 3 hemodialysis procedures were performed with laboratory tests monitored after each procedure. The interval between sessions of hemodialysis was 72 hours.

The double-lumen catheter installed during the first hemodialysis procedure was used for 4 procedures without any complaints or complications. Thus, 4 hemodialysis procedures were performed by means of a single puncture of the jugular vein, which greatly reduced the risks of complications such as local inflammation, hematoma, and bleeding. The animal was discharged in a stable condition, with normal clinical and laboratory parameters, namely:

creatinine - 125 µmol/l (normal 44-130 µmol/l)

urea - 4.4 mmol/l (norm 4-8 mmol/l)

phosphorus - 1.3 mmol/l (norm 1.1-1.8 mmol/l)

Na (sodium) - 147 mmol / l (norm 140-154 mmol / l)

K (potassium) - 4.8 mmol / l (norm 3.8-5.6 mmol / l)

Ph - 7.32 mmol / l (norm 7.35-7.50).

Example #2

Male German Shepherd breed, Shah, 4 years old, weight 35 kg, examined.

Diagnosis: acute renal failure on the background of antifreeze poisoning. Anuria. Severe condition, stupor, lying position.

The intervention was carried out in the conditions of the treatment room, after antiseptic treatment, the right jugular vein of the animal was punctured with a double-lumen Balton catheter (diameter 8F). The catheter was connected to a 200 ml dialysis circuit. The Fresenius 4008n hemodialysis apparatus was adjusted based on the parameters of the connected animal, namely the temperature of 37.5°C, the perfusion rate of 9 ml/min per kg. Produced a hemodialysis procedure lasting 3 hours 41 minutes. Ultrafiltration 724 ml. After the end of the procedure, the catheter was disconnected from the dialysis circuit, a "heparin lock" was installed by introducing 1.2 ml of a heparinized solution of 0.9% NaCl. The period after the procedure was standard, without complications, the catheter site without visual signs of inflammation, bleeding, hematoma, thrombosis. Positive dynamics of diuresis: 1.7 ml / kg per minute

After the procedure, a biochemical blood test was taken

To achieve the maximum effect, an additional hemodialysis procedure was carried out with the control of laboratory tests. The interval between sessions of hemodialysis was 72 hours.

The double-lumen catheter installed during the first hemodialysis procedure was used during 2 procedures without any complaints or complications. Thus, 2 hemodialysis procedures were performed by means of a single puncture of the jugular vein, which greatly reduced the risks of complications such as: local inflammation, hematoma, bleeding. The animal was discharged in a stable condition, with normal clinical and laboratory parameters, namely:

creatinine - 86 µmol/l (normal 44-130 µmol/l)

urea - 5.3 mmol/l (norm 4-8 mmol/l)

phosphorus - 1.4 mmol/l (norm 1.1-1.8 mmol/l)

Na (sodium) - 142 mmol / l (norm 140-154 mmol / l)

K (potassium) - 4.5 mmol / l (norm 3.8-5.6 mmol / l)

Ph - 7.42 mmol / l (norm 7.35-7.50).

The effectiveness of the procedure is confirmed by the positive dynamics of the animal's condition, the achievement of normal levels of uremic toxins and ion-electrolyte composition.

Sources of information

1. Nephrology and urology of dogs and cats / ed. J. Bainbridge, J. Eliot; per. from English. E. Makhiyanova. - M.: Aquarium-Print, 2008. - 272 p. Bonnet J.M., Cadoret J.M.

2. Pathophysiology of renal failure // Veterinarian. 2009. No. 8. S. 4-13.

3. Clinical evaluation of dietary modification for treatment of spontaneous chronic renal failure in dogs / Jacob F., Polyzin D.J., Osborne C.A. [et al.] // Journal of the American Veterinary Medical Association. - 2002. - V. 220. - P. 322-329.

4. Cowgill L.D., Francey T. Hemodialysis. In: DiBartola S.P., editor. Fluid, electrolyte and acid-base disorders in small animal practice. St Louis, ed. 3, 2006. Saunders.

Claims (1)

A method for hemodialysis in dogs weighing 8 kg or more, including hemocorrection and detoxification of the animal's blood using an extracorporeal circuit, characterized in that in dogs with a double-lumen catheter only the jugular vein is punctured once, the extracorporeal circuit is filled with 115-200 ml and blood is perfused through the blood line at a rate of 7-9 ml / min per kg of animal weight, at the end of the procedure, heparinized saline is injected into the lumen of the catheter as a “heparin lock”, after 3-5 days the procedure is repeated under the control of biochemical parameters 2-4 times until homeostasis normalizes.