Published in Scientific Works. Series C. Veterinary Medicine, Vol. LXIII, Issue 2
Written by Alina ȘTEFĂNESCU, Bogdan Alexandru VIȚĂLARU, Ion Alin BÎRȚOIU
Hemodialysis is used for the management of acute and chronic renal failure that is refractory to conventional medical therapy. For the moment, there are two types of hemodialysis: intermittent and continuous hemodialysis. Intermittent hemodialysis (IHD) is a renal replacement therapy that is defined by short and efficient hemodialysis sessions with the goal of removing endogenous or exogenous toxins from the bloodstream. IHD is indicated in cases of acute azotemia, electrolyte abnormalities or acidosis unresponsive to medical management. Continuous renal replacement therapy (CRRT) is a continuous process and, once treatment begins, therapy continues until renal function returns or the patient is transitioned to intermittent dialysis. The most common indication for CRRT is the treatment of acute kidney injury (AKI) in cases in which renal function is expected to return in the near future or for patients who are to be transitioned to IHD. Vascular access is the first and most basic requirement of successful extracorporeal renal replacement therapy (ERRT) and usually the jugular vein is used. Another vascular access consists of arteriovenous (AV) fistula or graft and it is the preferred access in patients with chronic hemodialysis. The ERRT catheter should be used only for ERRT procedures and handled only by ERRT personnel. When patients undergo IHD, their blood is removed from their bodies and run through an extracorporeal circuit. The blood is exposed to foreign material that may activate the clotting cascade. Therefore, anticoagulant therapy is often required during a dialysis treatment and special equipment is necessary for monitoring the level of anticoagulation. Complications of IHD have been widely reported and include hypotension and hypovolemia, vascular access problems and neurologic, respiratory, hematologic and gastrointestinal complications. The most significant complications of CRRT is coagulation. Despite appropriate heparin management, clotting of the CRRT circuit is inevitable.
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