Extracorporeal therapies

Extracorporeal therapies are medical treatments in which blood or other bodily fluids are removed from the body, treated externally, and then returned. These therapies are often used to eliminate waste products or toxins.

Hemodialysis

Hemodialysis is primarily used to remove waste products, excess fluids, and electrolytes from the blood when a patient’s kidneys are not functioning adequately. It can also be used to eliminate certain toxins from the bloodstream.

Indications:

• Acute kidney injury.
• Toxin ingestion involving small molecules (e.g., ethylene glycol).

Referral Criteria:

• Severe azotemia of acute origin (creatinine > 800 µmol/L; may be considered from > 400 µmol/L).
• Anuria or oliguria.
• Severe electrolyte disturbances (e.g., hyperkalemia).
• Volume overload or fluid overperfusion.
• Severe clinical signs of acute kidney injury that are not manageable with standard therapy.

Contraindications:

• Chronic kidney disease.
• Body weight < 4 kg (alternative methods such as peritoneal or pleural dialysis may be considered).
• Inability to place a central venous catheter due to absence of an intact jugular vein*.

On average, patients with acute kidney injury require 3–5 sessions.

Hemoperfusion

Indications:

• Toxin ingestion (e.g., NSAIDs, ivermectin, phenobarbital, potassium bromide, vincristine, baclofen, etc.).

Referral Criteria:

• Confirmed or strongly suspected toxin ingestion.

Contraindications:

• Animals < 4 kg (may still be referred for possible alternative therapies).
• Inability to place a central venous catheter due to absence of an intact jugular vein*.

On average, patients require 1 or 2 sessions.

Plasmapheresis

Indications:

• Immune-mediated diseases (e.g., myasthenia gravis, polyradiculoneuritis, immune-mediated hemolytic anemia).

Referral Criteria:

• Confirmed or strongly suspected autoimmune disease.
• Currently, the strongest evidence exists for its use in myasthenia gravis, polyradiculoneuritis, and immune-mediated hemolytic anemia]

On average, patients require 1 or 2 sessions.

*All of these techniques require the presence of an intact jugular vein, as a central venous catheter must be placed.