Renal replacement therapy in healthy adult horses.
Authors: Wong D M, Witty D, Alcott C J, Sponseller B A, Wang C, Hepworth K
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Renal Replacement Therapy in Healthy Adult Horses Acute renal failure remains a significant clinical challenge in equine practice, and whilst renal replacement therapy (RRT) is standard care for people with ARF, its feasibility in horses had never been systematically evaluated. Wong and colleagues conducted a prospective study on five healthy adult horses, using commercial hemodiafiltration equipment to perform six-hour RRT sessions with standardised flow rates (blood flow 250 mL/min, dialysate 3,000 mL/h) whilst monitoring cardiovascular stability, urine output, and comprehensive biochemical parameters. The system successfully achieved mean creatinine clearance of 68.9 mL/min and a 24% urea reduction ratio—both clinically meaningful figures—though notably the urea reduction was modest compared to human protocols. Beyond minor complications (significant hypothermia, mild thromboplastinemia and thrombocytopenia, and hyperphosphataemia), no serious adverse effects occurred, establishing the technical and physiological feasibility of RRT in adult horses. For practitioners managing cases of acute renal failure, these findings suggest that referral centres equipped with RRT capability may now offer a genuine interventional option to support renal recovery, though further work in naturally affected animals and optimisation of flow parameters will be needed before this becomes routine clinical practice.
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Practical Takeaways
- •Renal replacement therapy is a feasible treatment modality for equine acute renal failure and can be safely performed using commercially available equipment adapted for horses
- •Monitor body temperature closely during RRT procedures as significant hypothermia may develop; manage coagulation parameters and platelet counts as these show significant changes during treatment
- •This technique expands treatment options for horses with ARF, though the clinical efficacy in diseased horses with actual renal failure remains to be demonstrated
Key Findings
- •Continuous venovenous hemodiafiltration was successfully performed in healthy adult horses for 6 hours with mean creatinine clearance of 0.127 mL/kg/min and urea reduction ratio of 24%
- •Significant decreases in body temperature (P ≤ 0.007) and blood urea nitrogen (P < 0.001) were observed during RRT
- •Significant increases in serum phosphorus (P ≤ 0.001) and prolongation of prothrombin and partial thromboplastin times occurred with decreased platelet counts (P ≤ 0.04)
- •No adverse effects were detected, demonstrating that RRT can be safely implemented as a treatment option in adult horses