vet

1. Peritoneal Dialysis in Cats with Acute Kidney Injury:
22 Cases (2001 –2006)
R.L. Cooper and M.A. Labato
Background: Peritoneal dialysis (PD) has been described for use in animals with acute kidney injury refractory to fluid
therapy. However, no study has examined the use of PD in a large group of cats.
Hypothesis: PD is an important adjunctive therapy to treat acute kidney injury in cats.
Animals: The medical records of 22 cats with acute kidney injury that had received PD were examined. Animals were ex-
cluded if acute uremia was a result of postrenal causes such as uroabdomen or urethral obstruction.
Methods: Medical records were reviewed for the following: indication for PD, outcome, number of cycles performed, sur-
vival time, and predialysis and postdialysis results for blood urea nitrogen (BUN), creatinine, potassium, chloride, sodium,
phosphorus, total protein, and albumin concentrations, and urine output.
Results: Indications for PD include acute-on-chronic kidney injury, acute kidney injury caused by toxins, bilateral ureter-
oliths, bilateral ureteral ligation as a complication of ovariohysterectomy, and unknown causes. The median survival time for
all cats on PD was 4 days, although the median survival time for the cats that were discharged was 774 days. The most common
complications were dialysate retention and sequestration of dialysate SC. There was a significant (Po .05) decrease between
predialysis and postdialysis results for BUN, creatinine, potassium, phosphorus, total protein, and albumin concentrations.
There was a significant (Po .05) difference in survival times between sexes.
Conclusions and Clinical Importance: PD is an effective option for treatment of cats with acute kidney injury refractory to
fluid therapy.
Key words: Lily toxicity; Peritonitis; Urolithiasis.
Peritoneal dialysis (PD) is the process of utilizing the
peritoneum as a semipermeable membrane in order
to move solutes and water between blood in the perito-
neal capillaries and fluid (dialysate) instilled into the
peritoneal cavity.1
PD most frequently is used in man-
agement of acute kidney injury refractory to fluid
therapy, but it also has been used in management of se-
vere metabolic disturbances, acute poisoning with
dialyzable substances (eg, ethylene glycol, ethanol,
barbiturates), and severe temperature extremes.2
PD is performed by placing a catheter into the abdomen
that is attached to a closed collection system. A specialized
solution (dialysate) is infused into the abdomen, allowed
to dwell for a predetermined amount of time, and then re-
moved. The dialysate can be formulated in the clinic, or
can be purchased commercially. Standard commercial
dialysate solutions are designed to remove urea, creatinine,
potassium, and phosphate from the plasma into the dialy-
sate by the process of diffusion. A variety of dialysate
solutions can be used with differing osmolalities on a case-
by-case basis depending on the fluid balance of the patient.
Fluid and solutes move across the peritoneum by diffusion,
ultrafiltration, and convection. Urea and potassium diffuse
across the peritoneal membrane quickly, whereas creati-
nine and phosphorus take longer to equilibrate.3
In
humans receiving hemodialysis and PD, urea kinetics are
evaluated to assess the adequacy of treatments.
Several studies have reported on the technique of PD in
dogs.4–6
One study examined PD in both dogs and cats,
but only 2 cats were included in the study, and neither cat
survived.5
Another study recently evaluated PD in 6 cats.7
That study showed a better outcome in cats receiving PD
than did the previous study.5,7
The smaller population
size in this study made it difficult to evaluate trends and
prognostic indicators for survival. In addition, the use of
negative pressure during the outflow phase of each PD
cycle, which has not been described previously in the
veterinary literature, may have resulted in different com-
plications and outcomes of these patients compared with
those treated by standard methods of PD.7
The present
study examined the indications, effectiveness, outcomes,
and complications associated with the use of PD in cats
with acute kidney injury. It also evaluated the urea reduc-
tion ratio (URR) as a measure of dialysis adequacy and
predictor of survival in cats receiving PD.
Materials and Methods
Criteria for Selection of Cases
Medical records of 27 cats that had received PD at Cummings
School of Veterinary Medicine at Tufts University from January 1,
From the Foster Hospital for Small Animals, Cummings School
of Veterinary Medicine, Tufts University, North Grafton, MA
(Labato); and the Department of Clinical Studies, Matthew J. Ryan
Veterinary Hospital, University of Pennsylvania, Philadelphia, PA
(Cooper). Dr Cooper is presently affiliated with Department of Clin-
ical Studies, Matthew J. Ryan Veterinary Hospital of the University
of Pennsylvania, 3900 Delancey Street, Philadelphia, PA 19104. This
paper was presented as an abstract at the ACVIM Forum 2008.
Corresponding author: Mary Anna Labato, Foster Hospital for
Small Animals, Cummings School of Veterinary Medicine, Tufts Uni-
versity, 200 Westboro Road, North Grafton, MA 02135; e-mail:
mary.labato@tufts.edu.
Submitted February 25, 2010; Revised September 15, 2010;
Accepted October 20, 2010.
Copyright r 2010 by the American College of Veterinary Internal
Medicine
10.1111/j.1939-1676.2010.0655.x
Abbreviations:
BUN blood urea nitrogen
PD peritoneal dialysis
URR urea reduction ratio
J Vet Intern Med 2011;25:14–19

2. 2001 to December 31, 2006 were reviewed. Criteria for inclusion in
the study consisted of diagnosis of acute kidney injury and at least 1
PD cycle performed. Acute kidney injury was defined as a severe
and sudden decrease in glomerular filtration rate and subsequent
uremia. This study included cats with acute kidney injury caused by
toxin exposure, obstruction secondary to ureteroliths or ureteral li-
gation, acute exacerbation of chronic kidney injury, or unknown
causes. Five cats with uroabdomen because of bladder rupture were
excluded from the study. Twenty-two cats met the criteria for inclu-
sion into the study.
Data Collection
The following data were collected from each patient record and
recorded in a systematic fashion: sex, breed, age, weight, indication
for PD, number of dialysis cycles, number of days PD was per-
formed, outcome (discharge, euthanasia, or death), days from the
start of PD to endpoint (discharge from hospital versus euthanasia
or death), survival time (days) from onset of PD, and method of
catheter placement (surgical placement with omentectomy versus
nonsurgical placement). Complications noted from each patient’s
record (obtained from daily physical examination, treatment sheet,
and dialysis flow sheet) also were recorded.
Predialysis and postdialysis results were obtained for the follow-
ing variables: blood urea nitrogen (BUN), creatinine, phosphorus,
sodium, potassium, chloride, total protein, albumin, and urine out-
put (mL/kg/h). When available, blood glucose concentrations were
recorded for the duration of dialysis. In those cases in which cats
died or were euthanized before completion of dialysis, the postdial-
ysis results were those obtained closest to death or euthanasia. In 1
cat that experienced cardiac arrest after the 1st PD cycle, postdial-
ysis results were not obtained.
When possible, URR was calculated for each of the cats at 6, 12,
24, 36, 48, and 72 hours after starting dialysis by the following
formula:
URR ¼ ðBUNpre BUNpostÞ=BUNpre 100
where the BUNpre is the predialysis BUN and BUNpost is the BUN
recorded at specific time intervals.
Statistical Analyses
Mean, median, and standard deviation were calculated for each
variable noted above. With the exception of urine output predialysis
and postdialysis, all results were compared by a paired t-test. Be-
cause urine output data were not evenly distributed a signed-rank
test was used. Kaplan-Meier estimates of survival times from onset
of PD for age, sex, indications for PD, predialysis results for BUN,
creatinine, potassium, phosphorus, sodium, chloride, total protein,
albumin, and urine output were computed by a commercial statis-
tical software package.a
Mean and median survival time was
calculated by the area under the curve for each variable. The Man-
tel-Cox log-rank analysis was performed to compare the survival
distributions for different levels of the variables above. The follow-
ing divisions were made in comparing different variables: age: o8,
8; number of cycles: 10, 10–50, 50; BUN: o150, 150–250,
4250 mg/dL; creatinine: o8, 8–16, 416 mg/dL; phosphorus: o10,
10–20, 420 mg/dL; sodium: o140, 140–149, 4149 mEq/L; chlo-
ride: o119, 119 mEq/L; potassium: 8, 48 mEq/L, total protein:
6, 46 g/dL; albumin: 2.8, 42.8 g/dL; urine output: o1, 1 mL/
kg/h. Mann-Whitney rank-sum tests were used to compare URR
between survivors and nonsurvivors at different time periods.
Results
Animals
Of the 22 cats examined, 14 were castrated males and 8
were spayed females. A variety of breeds were repre-
sented, including Domestic Short Hair (n 5 14),
Domestic Long Hair (n 5 3), Siamese (n 5 2), Russian
Blue (n 5 1), Himalayan (n 5 1), and Maine Coon (n 5
1). The average age at presentation was 7.2 years (range,
9 months–17.4 years).
The most common indication for PD was acute-on-
chronic kidney injury (7/22; 32%). Urolithiasis ac-
counted for 23% (5/22) of cases, 18% (4/22) of cats
presented with acute kidney injury because of toxicity, 3
of which were a result of lily toxicity, and 1 was an un-
known toxin. Acute kidney injury was attributed to spay
complications in 14% (3/22) of cats (bilateral ureteral
ligation in 2 cats and unknown in 1 cat). Fourteen per-
cent (3/22) of the cats presented with acute kidney injury
of unknown cause.
Response to PD
There was a significant difference (Po .05) in mean
predialysis and postdialysis results for BUN (Po .001),
creatinine (P 5 .003), phosphorus (P 5 .03), potassium
(P 5 .03), total protein (Po .001), and albumin (Po
.001) concentrations (Table 1). There was no significant
difference in predialysis and postdialysis results for so-
dium (P 5 .55) and chloride (P 5 .26) concentrations,
and urine output (P 5 .21).
Outcome
The average number of PD cycles performed was 33.7
(median, 17; range, 1–238). Of 22 cats, 10 cats (45.5%)
were discharged from the hospital after PD. Seven cats
(31.8%) were euthanized before discharge from the hos-
pital and 5 cats (22.7%) died in the hospital while
receiving PD. One cat was discharged from the hospital
with the PD catheter in place, and came back daily for
PD catheter irrigation for 10 days in the event that PD
would be necessary again. The PD catheter in this cat was
removed 10 days after discharge from the hospital after
laboratory test results showed that azotemia was being
controlled by SC fluid administration.
Predictors of Survival
Sex. By a Kaplan-Meier curve and the Mantel log-
rank test, there was a significant difference (P 5 .038) in
survival time between males and females. Five of 8
females (62.5%) survived to discharge, whereas only 5/
14 (35.7%) males survived to discharge.
Indication for PD
There was no significant difference (P 5 .09) in sur-
vival time regardless of the indication for PD by the
Mantel log-rank test. All 3 cats with spay complications
were discharged from the hospital. None of the cats with
15
Peritoneal Dialysis in Cats

3. spay complications had urine cultures performed within
48 hours of admission to the hospital.
Sixty percent (3/5) of cats with urolithiasis-induced
acute kidney injury were discharged from the hospital.
Of the 2 cats in this group that did not survive, 1 was eu-
thanized and 1 died. Eighty percent (4/5) of cats with
urolithiasis had urine cultures performed within 48 hours
of admission. None of these urine cultures were positive
for bacterial growth.
Three of 7 (42.8%) cats with acute-on-chronic kidney
injury were discharged from the hospital. Three of the 4
cats that did not survive to discharge were euthanized
and 1 died. Urine cultures were performed within 48
hours of presentation to the hospital in 42.8% (3/7) of
cats with acute-on-chronic kidney; none of the urine cul-
tures were positive for bacterial growth. One of the cats
that had a negative urine culture on admission had a his-
tory of a positive urine culture (Escherichia coli) 2 weeks
before presentation, and had been treated with antibiot-
ics. One additional cat had a urine culture performed by
a referring veterinarian the day before presentation, but
those culture results were not available. End-stage kid-
neys were noted on necropsy in the 2 cats that did not
have urine cultures performed on admission.
Of the cats presented for toxicities, there were no sur-
vivors (0%, 0/4). Three of the toxin exposures were
confirmed to be lily toxicity; 1 cat had evidence on nec-
ropsy of nephrotoxin exposure. Three of these cats were
euthanized and 1 died (Fig 1). All cats presented with
toxicities had urine cultures performed within 48 hours
of presentation and 50% had positive urine cultures.
Both of these cultures were positive for E. coli.
Predialysis results for BUN, creatinine, potassium,
phosphorus, total protein, albumin, and urine output
were not significant predictors of survival time by Mantel
log-rank test (P 4 .05).
Urea Kinetics
Urea kinetics could be determined for a small number of
animals at each time point. There was no significant differ-
ence in URR between survivors and nonsurvivors at 12
hours (P 5 .083), 48 hours (P 5 .99), or 72 hours (P 5
.564). There was a significant difference (P 5 .032)
between survivors and nonsurvivors for URR at 24 hours
postdialysis. The median URR for survivors at 24 hours
was 44.2 compared with 6.6 for nonsurvivors (see Table 2).
Complications of PD
The most common complication of PD was dialysate
retention, which affected 77% (17/22) of the cats. Fifty
percent (11/22) of the cats had sequestration of dialysate
under the skin, 13.6% (3/22) had obstructed PD cathe-
ters, 9% (2/22) had leakage of fluid from the catheter site,
and 9% (2/22) had abdominal pain. One cat developed
septic peritonitis caused by Klebsiella pneumoniae
(4.55%), 1 cat developed hemorrhagic dialysate and
subsequently experienced cardiac arrest, 1 cat had dehis-
cence of its surgical incision, and 1 cat developed pleural
effusion.
Hypoproteinemia was the most common laboratory
abnormality noted, with 90% (18/20) of cats exhibiting
Fig 1. Survival curve for 22 cats with acute kidney injury treated
with peritoneal dialysis (PD) divided by indications for PD. There
was no statistically significant difference (P 5 .09) between survival
times based on indications for PD.
Table 1. Summary of serum creatinine, blood urea nitrogen (BUN), total protein, and albumin concentrations, and
urine output in 22 cats treated with PD.
Predialysis
(Mean) Range
Postdialysis
(Mean) Range
Reference
Range P-Value
Mean Values
at Discharge Range
BUN (mg/dL) 212.1 68–462 123.0 12–265 8–29 o.001 54.0 11–108
Creatinine (mg/dL) 14.6 4.1–26.3 8.3 0.6–19.3 0.6–2.0 .000 4.1 0.8–10.9
Phosphorus (mg/dL) 13.9 5–25.5 10.2 3.7–18.3 2.6–7.2 .03 7.0 4.2–14.1
Potassium (mEq/L) 7.36 4.7–10.5 5.55 4.8–8 3.8–5.4 .003 5.0 3.5–5.9
Sodium (mEq/L) 147 130–158 146 132–157 142–158 .55 154.9 146.3–159.0
Chloride (mEq/L) 109 84–127.4 111 96–126.6 106–126 .26 114.9 110.0–120.0
Total protein (g/dL) 6.24 4.5–8.1 4.86 3.2–6.7 5.5–7.8 o.001 6.1 4.0–8.0
Albumin (g/dL) 2.93 1.9–3.7 2.21 1.2–3 2.8–4.0 o.001 3.0 2.3–3.5
Urine output (ml/kg/h) 1.46 0–14.62 9.23 0–98.9 1–3 .14 N/A N/A
PD, peritoneal dialysis.
16 Cooper and Labato

4. low total protein concentration after undergoing PD.
Hypoproteinemia was present in 38.1% (8/20) of the cats
before starting PD. Sixteen percent (3/18) of the cats
were hypoalbuminemic before starting PD; posttreat-
ment, this number increased to 68.8% (11/16). Hypo-
natremia was seen in 13/22 cats (59.1%) before PD and
in 13/21 (61.9%) after PD. Hypochloremia was identified
in 77.3% (17.22) of the cats before PD and in 85.7% (18/
21) after PD. Hypokalemia was not noted in the post-PD
laboratory evaluation in the present study.5
Hyper-
glycemia was identified in 3/22 (13.6%) of the cats
during the course of PD.
Placement of PD Catheters
Twelve cats (54.5%) had surgical placement of their
PD catheters with partial omentectomy. Of these cats, 7/
12 (58.3%) had retained dialysate or an obstructed cath-
eter as a complication noted in the medical record. Half
of the animals with surgical placement of the catheter (6/
12) had SC leakage of dialysate as a complication.
Eight cats (36.4%) had percutaneous placement of PD
catheters. One hundred percent of these animals had re-
tained dialysate, an obstructed PD catheter, or both
noted as a complication and 5/8 (62.5%) had SC leakage
of dialysate as a complication.
Two cats (9.0%) initially had percutaneous placement
of their PD catheters, but eventually required surgical
placement of PD catheters caused by catheter outflow
complications. One of these cats had a surgically placed
catheter, but no partial omentectomy and continued to
have complications involving retained dialysate. This cat
was reoperated and a partial omentectomy performed
and fewer complications were reported postoperatively.
Not all records noted the type of catheter placed. Sev-
eral different types were noted, including Quinton
Pediatric Peritoneal Dialysis catheter,b
Malecot cathe-
ter,c
Swan Neck Missouri Peritoneal Dialysis catheter,d
and the T-style fluted catheter.e
The percutaneously
placed types of PD catheters had a much higher occur-
rence of dialysate retention.
Discussion
Although overall survival time was poor, animals that
are considered for PD are severely ill and have not shown
signs of improvement with conventional therapy. Also,
the majority of cats that did not survive to discharge were
euthanized, and time and financial commitment may
have factored into the decision to euthanize.
There was a significantly longer survival time for
females than males in this study. One factor that may
contribute to this observation is the group of 3 cats that
had bilateral ureteral ligation after ovariohysterectomy.
All 3 of these cats had surgical correction of this compli-
cation in addition to PD. These cats experienced acute
kidney injury at a younger age than did the animals with
other indications for PD. Therefore it is not surprising
that these cats had longer survival times than did the
other groups.
Table
2.
Summary
of
URR
in
surviving
and
nonsurviving
cats
with
acute
kidney
injury
treated
with
PD.
12
Hours
24
Hours
48
Hours
72
Hours
N
Median
Mean
Range
N
Median
Mean
Range
N
Median
Mean
Range
N
Median
Mean
Range
Survivors
4
10.46
11.17
27.54–3.77
3
44.17
41.60
33.22–47.4
4
38.93
28.13
23.53–85.94
3
60.12
33.25
26.47–66.1
Nonsurvivors
4
9.84
13.16
9.68–42.64
4
6.62
9.60
4.12–29.17
4
22.9
27.11
13.82–48.75
2
38.69
38.69
21.13–56.25
PD,
peritoneal
dialysis;
URR,
urea
reduction
ratio.
Significant
difference,
P
5
.032.
17
Peritoneal Dialysis in Cats

5. In this study, all 4 cats with toxicity did not survive.
This is a lower survival rate than in previous studies on
Easter lily toxicosis in cats.8,9
The lower rate of survival
may have been because of increased severity of the cases
that were considered for PD. The damage sustained by
the kidneys at such a late stage may be irreversible by the
time PD is initiated. A previous study reported the use of
hemodialysis in management of 2 cases of acute kidney
injury caused by lily ingestion in cats.8
Both of the cats
with disease serious enough to warrant hemodialysis died
in the hospital. The poor prognosis and expense of care
also may have influenced the decision for euthanasia in
these cases as well. The small number of cats in this study
necessitates cautious interpretation of these results.
The complication rate was relatively high, although most
complications were not life threatening. Dialysate retention,
sequestration of dialysate under the skin, and obstructed
PD catheters were the most common complications.
Peritonitis is a well-described complication of PD.3,10,11
A previous study showed an increased risk of peritonitis
with increasing number of days on PD, which was true for
the present study as well.5
The 1 cat that was diagnosed
with peritonitis was the patient that spent the longest time
on dialysis (10 days) and had the largest number of cycles
(238). The bacteria cultured in this case of peritonitis was
Klebsiella, which was found to be one of the most com-
mon bacterial isolates in a previous study.5
Pleural effusion was a complication seen in 1 cat in this
study. Pleural effusion has been described previously as a
complication of PD in a dog, and was suggested to be
because of a pleuroperitoneal connection.12
Glucose con-
centration of the pleural effusion was not measured in the
current case, so it was not possible to differentiate
whether the pleural effusion was because of a pleuroperi-
toneal connection or fluid overload.
Although the catheter outflow complication rate was
high for both percutaneous and surgically placed cathe-
ters, it was lower for surgically placed catheters (58.3%)
compared with the 100% complication rate of percuta-
neously placed PD catheters. The importance of partial
omentectomy is highlighted by the case in which a cath-
eter initially was placed surgically without partial
omentectomy but the patient continued to have compli-
cations until partial omentectomy performed, at which
time the complications resolved. There were not enough
data on the specific types of catheters used in this study to
determine whether particular types of catheters affected
the rate of catheter outflow complications, although
other studies have remarked on complication rates of
different catheters.13
In human patients receiving hemodialysis and PD, urea
kinetics are used to assess adequacy of the dialysis dose.
Generally, this involves calculating the fractional clear-
ance of urea (Kt/V). This value requires measurements of
urea clearance, both in dialysate and urine, as well as the
daily urea generation rate. Because of the retrospective
nature of this study, these values could not be obtained
from existing patient data. URR has been described as an
easier method to evaluate the effectiveness of dialysis in
human patients receiving hemodialysis and PD.14
In at
least 1 study, URR has been evaluated as a predictor of
mortality in humans undergoing hemodialysis.15
In this
study, a lower URR was associated with increased risk of
mortality.15
In our study, we investigated the use of the
URR as a predictor of survival in cats receiving PD.
In all measurements except for the 24-hour period, there
were no significant differences in mean URR between sur-
vivors and nonsurvivors. Survivors had a lower URR
than did nonsurvivors for the 24-hour period. The 12-
hour mean URR for survivors was negative (ie, the mean
BUN of survivors increased compared with predialysis re-
sults, whereas the mean BUN of nonsurvivors decreased).
It is difficult to interpret these results based on several
aspects of data collection. Most cats in the study did not
receive dialysis for 72 hours. As cats improved, PD was
stopped, and many of the cats that did well did not re-
ceive PD for longer time periods. Thus, the longer time
periods may have included animals that were more re-
fractory to PD. Cats that fared poorly often were
euthanized or died before 24 hours on PD, and no data
could be collected for these cats. Cats that did well on PD
and were weaned off dialysis before 24 hours also did not
have URR calculated. Another problem that contributed
to the low number of URR calculated was related to the
method of measurement of BUN. All cats on PD had re-
nal function monitored at least once daily with a clinical
chemistry analyzer.f
Additional reevaluation of renal
function, electrolytes, and acid-base balance was per-
formed on a NOVA cage-side analyzer,g
which has an
upper limit of measurement of 130 mg/dL for BUN. Al-
though most cats had frequent reevaluation of renal
function, many of them had a BUN concentration
4130 mg/dL; therefore, URR could not be calculated
for cats when BUN was measured by the NOVA cage-
side analyzer. Because of these issues, not enough data
could be collected to draw conclusions regarding the util-
ity of the URR as a predictor of survival in this
population. However, despite many issues with measure-
ment of URR and urea kinetics in this population,
additional study is recommended in patients receiving
hemodialysis and PD.
In cases of acute kidney injury refractory to fluid ther-
apy, both hemodialysis and PD are treatment options
that can be considered. Hemodialysis requires specialized
training, equipment, and water purification systems and
is also not readily available to most veterinarians. PD is
labor intensive, but does not require specialized equip-
ment and may be performed in any clinic with adequate
technical assistance and supervision. Patient personality
also must be considered when deciding to perform PD
because the patient must tolerate frequent manipula-
tions. PD is an important therapeutic tool for mitigating
clinical signs of uremia and giving the kidneys time to re-
cover in cats with acute kidney injury when conventional
therapy is no longer effective.
Footnotes
a
SPSS for Windows version 13.1, SPSS Inc, Chicago, IL
b
Kendall Inc, Mansfield, MA
18 Cooper and Labato

6. c
Cook, Spencer, IN
d
Kendall Inc
e
Ash Advantage, Medigroup Inc, Aurora, IL
f
COBAS 6000, Roche Diagnostics, Indianapolis, IN
g
Stat Profile, NOVA Biomedical Corporation, Waltham MA
Acknowledgments
The authors acknowledge Lori Lyn Price and Dr Lou-
ise Maranda for assistance in statistical analysis. This
study was not supported by any funding or grants.
References
1. Ross LA, Labato MA. Peritoneal dialysis In: DiBartola SP
ed. Fluid, Electrolyte, and Acid-Base Disorders in Small Animal
Practice. London, UK: Saunders Elsevier; 2006:635–649.
2. Dzyban LA, Labato MA, Ross LA, et al. Peritoneal dialysis:
A tool in veterinary critical care. J Vet Emerg Crit Care 2000;10:
91–102.
3. Cowgill LD. Application of peritoneal dialysis and hemodial-
ysis in the management of renal failure In: Osborne CA, Finco DR
eds. Canine and Feline Nephrology and Urology. Baltimore, MD :
Williams and Wilkins; 1995:573–596.
4. Nam SJ, Choi R, Oh WS, et al. Peritoneal dialysis in dogs: 20
cases (2006–2008). J Vet Clinics 2009;26:23–28.
5. Crisp MS, Chew DJ, DiBartola SP, et al. Peritoneal dialysis
in dogs and cats: 27 cases (1979–1987). J Am Vet Med Assoc
1989;195:1262–1266.
6. Beckel NF, O’Toole TE, Rozanski EA, et al. Peritoneal
dialysis in the management of acute renal failure in 5 dogs with
leptospirosis. J Vet Emerg Crit Care 2005;15:201–205.
7. Dorval P, Boysen SR. Management of acute renal failure in
cats using peritoneal dialysis: A retrospective study of six cases
(2003–2007). J Fel Med Surg 2009;11:107–115.
8. Langston CE. Acute renal failure caused by lily ingestion in
six cats. J Am Vet Med Assoc 2002;220:49–52.
9. Rumbeiha WK, Francis JA, Fitzgerald SD, et al. A compre-
hensive study of easter lily poisoning in cats. J Vet Diagn Invest
2004;16:527–541.
10. Thornhill JA, Riviere JE. Peritonitis associated with perito-
neal dialysis: Diagnosis and treatment. J Am Vet Med Assoc 1983;
182:721–724.
11. Thornhill JA. Peritoneal dialysis in the dog and cat: An up-
date. Compend Contin Educ Pract Vet 1981;3:20–34.
12. Carter LJ, Wingfield WE, Allen TA. Clinical experience with
peritoneal dialysis in small animals. Comp Contin Educ 1989;11:
135–143.
13. Dyzban LA, Labato MA, Ross LA. CVT update: Peritoneal
dialysis In: Bonagura JD, ed. Kirk’s Current Veterinary Therapy
XIII Small Animal Practice. Philadelphia, PA: W.B. Saunders Co;
2000:859–861.
14. Kessler E, Ritchey NP, Castro F, et al. Urea reduction ratio
and urea kinetic modeling: A mathematical analysis of changing di-
alysis parameters. Am J Nephrol 1998;18:471–477.
15. Owen WF, Lew NL, et al. The urea reduction ratio
and serum albumin concentration as predictors of mortality in
patients undergoing hemodialysis. N Engl J Med 1993;14:
1001–1006.
19
Peritoneal Dialysis in Cats