University of Veterinary Medicine Budapest

Dialysis at the University of Veterinary Medicine Budapest

What is dialysis good for?

Dialysis refers to the medical technology of artificially removing waste materials from the body. In a healthy organism, the kidneys perform this function. Still, in case of severe kidney damage, detoxification is inadequate, and the accumulated waste products can lead to severe symptoms (uremia) and even death. Therefore, dialysis is also called renal replacement therapy.

What types of dialysis exist?

Technically, there are two types of dialysis. 

During hemodialysis, a part of the patient’s blood is removed from the body, cleaned through a filter (dialyzer), and then returned to the patient. In the filter, the patient’s blood flows on one side of the semipermeable membranes and dialysis fluid on the other side. Toxins are transferred from the blood into the dialysis fluid, and the purified blood is then returned to the patient. The structure of the membrane and the composition of the dialysis fluid allow only the toxins to be removed from the blood, while important blood components remain in the circulation. We offer two types of hemodialysis treatments: for larger-sized dogs (> 12-15 kg), we do intermittent hemodialysis (IHD, meaning 4-6 hour-long treatments) while for smaller patients (<12-15 kg) we offer continuous renal replacement therapy (CRRT, meaning 10-20 hours of treatment).

In case of peritoneal dialysis, the peritoneum is used as the semipermeable membrane through which toxins are removed from the body. A dialysis catheter is surgically implanted into the abdominal cavity. The abdominal cavity is filled with a special dialysis fluid through the catheter. Toxic substances are filtered into this fluid through the peritoneum, then the fluid is drained, and the abdominal cavity is refilled with fresh dialysis solution. This fluid change is repeated several times a day.

Which procedures are available at the Small Animal Clinic of the University of Veterinary Medicine Budapest?

We have been offering peritoneal dialysis in our clinic for many years, and after long preparations, we introduced hemodialysis in 2019.

When is dialysis therapy indicated?

The indication of dialysis in veterinary medicine is an acute kidney injury with a sudden onset. For example, intoxications (painkiller drugs, antifreeze, lily, raisins), kidney injury after longer anaesthesia, or infectious diseases like babesiosis or leptospirosis.

After an acute injury, the kidneys are able to regenerate to some extent; in some cases, even complete recovery is possible. The degree of recovery depends on the cause itself, the severity of the injury, and the available treatment.

However, it often takes days to weeks for the regeneration to begin. If the work of the impaired kidneys is not artificially replaced during this time, the patient dies within a few days due to the accumulation of waste products. The task of dialysis is, therefore, to take over the role of the kidneys until they can regenerate. Dialysis should be continued until the kidneys can perform the detoxification function of the body. It may take a few days to a few weeks. Unfortunately, it also happens that kidney function does not improve at all, or even if it does, it is insufficient, and chronic kidney disease remains.

It is important to understand that dialysis treatment does not accelerate kidney healing. The task of dialysis is to temporarily take over the function of the kidneys (detoxify the body, regulate the fluid, acid-base, and electrolyte balance) until the kidneys regenerate. In other words, to keep the patient alive until the kidneys are functional again. 

Is there a guarantee that my pet will fully recover with the help of dialysis?

Unfortunately, there is no guarantee. At the moment of admission to the intensive care unit, when we see that the pet’s kidneys have suddenly stopped, we cannot predict how much regeneration will take place. It may be 100%, or it may only be 10%. Of course, there are good prognostic signs (e.g., acceptable general condition, satisfactory urine production) and bad prognostic signs (poor general condition, oral ulcerations, severe uremic symptoms, complete lack of urine production) that help us to establish the prognosis. 

How is a dialysis treatment carried out technically?

The pet with acute renal failure is admitted to the intensive care unit of our hospital, and supportive therapy is initiated. Various tests are carried out (blood-, urine test, ultrasound, blood pressure measurement, etc.) to asses the severity of kidney damage and to look for the possible cause if it is unknown. If, based on the examination results and the course of the disease, dialysis therapy is needed, the patient’s owner will be informed of the course and cost of the treatment.

In case of hemodialysis, a special dialysis catheter is inserted into the jugular vein (on the neck) under general anaesthesia. If the patient has severe anaemia, it also receives a blood transfusion before or during the dialysis treatment. The duration of one treatment is determined by the severity of the animal’s condition and the laboratory parameters. An intermittent hemodialysis treatment (for dogs >12-15 kg) usually lasts 4 to 6 hours. The patient is under veterinary supervision during the whole treatment. Dialysis treatments are usually performed on days 1, 2, and 4. Smaller-sized animals (<12-15 kg) are treated on a different dialysis machine and with a different type of treatment, as their blood circulation is much more unstable. In their case, we use so-called “continuous renal replacement therapy” (CRRT), during which the first two dialysis treatments are performed together, so the treatment lasts for 10-12 hours, sometimes even longer. If needed, this treatment is repeated after 2-3 days.

On day 5-6, we reevaluate the patient’s condition and laboratory parameters, and whether there is any improvement. Either there is a considerable improvement, and we can stop the dialysis treatments, or there is an improvement, but further treatments are necessary, or there is no improvement at all, and it is meaningless to continue the treatment. If we decide to continue the dialysis therapy, it will usually be needed 2-3 times a week. We repeat the dialysis treatments until the kidneys regain their function (a few days to a few weeks) or, in the worst case, until it becomes clear that the kidneys will not regain their function.

In the case of peritoneal dialysis, a special catheter is surgically inserted into the abdominal cavity under general anaesthesia. The abdominal cavity is filled with a special dialysis fluid through the catheter. Toxic substances are filtered into this fluid through the peritoneum, then the fluid is drained, and the abdomen is refilled with fresh dialysis solution. This process is initially repeated every 2 hours. Once the patient’s circulation has stabilized, and its general condition is acceptable, the number of dialysis sessions can be reduced to 4-6 times daily. Fluid changes are continued until the kidneys regain their function (a few days to a few weeks) or, in the worst case, until it becomes evident that the kidneys will not regenerate. If the pet is stable on dialysis and does not require further intensive care, peritoneal dialysis can be continued at home. The exact steps of the process will be taught to the owners. Home dialysis requires a great effort from the owners. The owners have to assess whether they will be able to do it or not. They will have to change the fluid 4-5 times a day, which takes approximately 20-30 minutes each, and they have to be able to give medications orally. As the patient’s condition improves, the number of dialysis sessions can be gradually reduced, and once dialysis is not needed, the catheter has to be removed during a small operation.

Before and after dialysis treatment (both peritoneal and hemodialysis), patients are placed in the intensive care unit (ICU) where they are under continuous (0-24) observation and are receiving medication and (if necessary) infusion therapy.

Does dialysis make sense in animals with chronic kidney disease?

Dialysis of pets with chronic kidney disease is not recommended. In people with chronic kidney disease, dialysis is continued until they receive a kidney transplant. Since this is generally not an option for pets, dialysis should be continued lifelong. 

Lifelong dialysis is limited on the one hand by the owner (time, energy and money requirements), and on the other hand by the patient. We can not provide a good quality of life on long term dialysis for our pets (continuous treatments, examinations, interventions, complications, general discomfort because of the disease).

What are the costs of dialysis?

Both hemodialysis and peritoneal dialysis are advanced, intensive therapeutic interventions. Because pets in need of dialysis are generally patients in poor condition, they require intensive care as well. Hence, in addition to the cost of dialysis, the cost of the intensive care, further treatments, examinations, and laboratory tests will also be calculated. 

Prices provided here are for information purposes only. The exact costs can vary from case to case and will be discussed on-site. 

First evaluation whether dialysis therapy is needed (usually physical examination, blood, urine test, ultrasound examination): approx. 250-300 euro

Hospital daily fees (including continuous monitoring, regular physical examinations and blood pressure measurements, special nutrition, medicines, infusions): approx. 150-220 euro

Laboratory fees (mostly blood tests): approx. 50-100 euro / day

Blood transfusion (if needed): approx 200 euro

Hemodialysis treatment:

Implantation of a special dialysis vein catheter on the first day approx. 250-400 euro

Cost of one intermittent hemodialysis (IHD) treatment (4-6 hours) with hourly blood tests: approx. 500-700 euro

Cost of one continuous renal replacement therapy (CRRT): 650-800 euro for 6 hours, then 70-100 euro hourly.

Peritoneal dialysis:

Implantation of a special dialysis catheter in the abdominal cavity: approx. 500 euro

Daily intensive care fees and laboratory costs: 200-320 euro

Adding these costs, the average price of the first week of intensive care:

on IHD (with 3-4 treatments) is 3500-4500 euro. If we continue the treatments and intensive care the average price is 2000-3000 euro/week.

on CRRT (with 2 prolonged treatments) 4000-5000 euro. If we continue the treatments and intensive care the average price is 2500-3000 euro/week.

on peritoneal dialysis is around 2000-2500 euro. If we continue the treatments and intensive care the average price is 1200-1600 euro/week.

A prepayment of at least 1000 euro is needed at the time of hospitalization. 