International renal interest society best practice consensus guidelines on the use of continuous renal replacement therapy in dogs and cats

Acute kidney injury (AKI) is a significant cause of morbidity and mortality in small animal practice. Early recognition and medical management form the basis of treatment, however, for dogs and cats with severe AKI, resulting in the development of uremic metabolic derangements and oligoanuria, advanced renal replacement therapy (RRT) should be considered. Different platforms (i.e. machines) and modalities are available for the delivery of RRT including intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) providing different but complimentary therapeutic options for the management of AKI. Intermittent hemodialysis is a short (i.e., few hours) and typically highly efficient treatment, whereas CRRT typically is less efficient but delivered continuously (≥24 h) which brings some advantages, especially for severely uremic or hemodynamically unstable animals. Working within the constraints of veterinary medicine and limitations that may exist in hospital staffing, facilities and finances, hybrid therapeutic protocols (e.g. prolonged intermittent renal replacement therapy (PIRRT; 6-12 h)) and transitional-CRRT (12-24 h) have been developed to advance the use of renal replacement platforms to fit with these logistical requirements. The literature on CRRT in veterinary patients is extremely limited, however, the demand for extracorporeal-based RRT therapies is expanding rapidly. Therefore, guidelines are required to ensure safe and effective operation and to optimize the management of dogs and cats with AKI using these platforms. To that end, these consensus-based best practice guidelines provide current knowledge on veterinary patient considerations, prescription, anti-coagulation, machine-based monitoring and commonly identified complications that may be experienced during CRRT, based on collective expert opinion.