Blog Post
June 14, 2025, 12:00 AM
Advanced Lifesaving Technologies: Dr. Simona Buoncompagni Explains Hemodialysis and Extracorporeal Therapies on “Your Vet Wants You to Know”
When faced with critically ill pets suffering from acute kidney injury, toxin ingestion, or autoimmune diseases, veterinary professionals need access to the most advanced treatment options available. In a follow-up to her earlier discussion on acute kidney injury, veterinary internal medicine specialist Dr. Simona Buoncompagni returns to the podcast “Your Vet Wants You to Know” to demystify the life-saving world of hemodialysis and advanced extracorporeal therapies for pets. This comprehensive episode provides veterinary professionals with essential insights into when and how these sophisticated treatments can dramatically improve outcomes for our most critically ill patients.
Understanding Hemodialysis: An Artificial Kidney for Pets
Dr. Buoncompagni expertly explains how hemodialysis functions as an artificial kidney system, mimicking the natural filtration processes that healthy kidneys perform. During hemodialysis, blood is pumped through a specialized machine and filtered through a dialyzer—essentially an external artificial kidney—before being returned to the patient’s body. This process effectively removes toxic waste products that accumulate when kidneys fail to function properly, as well as directly eliminating ingested toxins from the bloodstream.
The procedure itself is not painful and does not require general anesthesia. Pets typically rest comfortably during treatment sessions, which can last several hours. A venous catheter is placed in the jugular vein to allow for repeated treatments when necessary, and patients are closely monitored throughout each session with regular checks of blood work, vital signs, and blood pressure.
When Hemodialysis Becomes Essential: Critical Indications
The most common indication for hemodialysis in canine and feline patients is acute kidney injury (AKI), also known as acute renal failure or acute renal disease. Dr. Buoncompagni emphasizes that “The earlier we can intervene with dialysis, the better for the patient,” particularly in cases where patients develop insufficient urine output leading to fluid retention, edema, or life-threatening hyperkalemia.
Key indications for hemodialysis include:
Acute Kidney Injury Management: When conventional fluid therapy and medical management prove insufficient, hemodialysis provides critical support while allowing damaged kidneys time to recover. Mortality due to acute kidney injury has been reported to be ranging from 23.8 to 78.5% in dogs, making early intervention with advanced therapies crucial.
Toxin Removal: For pets that have ingested potentially fatal substances, hemodialysis can directly remove toxins from the bloodstream before they cause irreversible damage. Only one dialysis session is necessary and it is often possible to discharge the patient the following day when treatment is initiated promptly after toxin exposure.
Autoimmune Disease Support: Advanced extracorporeal therapies can help manage severe autoimmune conditions by removing harmful antibodies and inflammatory mediators from circulation.
The Spectrum of Extracorporeal Therapies
Beyond traditional hemodialysis, Dr. Buoncompagni discusses the expanding toolkit of extracorporeal therapies available for veterinary patients:
Hemoperfusion: Using a specialized filter, this treatment removes substances from the blood or plasma such as toxins, cytokines and pathogens. It can be provided alone or in combination with hemodialysis or therapeutic plasma exchange. Some toxins require this specialized setup for effective removal.
Therapeutic Plasma Exchange (TPE): TPE utilizes a machine that separates blood into red blood cells and plasma. TPE may be recommended for specific intoxications or to treat immune mediated diseases. During the treatment, the plasma containing toxins or antibodies is removed and replaced with fresh plasma.
Continuous Renal Replacement Therapy: For critically ill patients requiring ongoing support, continuous therapies provide gentler, round-the-clock treatment that better mimics natural kidney function.
Common Toxins Requiring Extracorporeal Intervention
Dr. Buoncompagni highlights several categories of toxins where hemodialysis or hemoperfusion can be life-saving:
- Household toxins: Antifreeze (ethylene glycol), which can cause rapid kidney failure if not treated immediately
- Food toxins: Grapes or raisins (in dogs), lilies (in cats), which can cause severe acute kidney injury
- Medications: The muscle relaxant baclofen, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), many antibiotics, chemotherapeutics and seizure medications in cases of accidental overdose
- Environmental toxins: Pesticides, herbicides, rodenticides, and heavy metals
The Treatment Process: What to Expect
Dr. Buoncompagni provides valuable insights into the practical aspects of extracorporeal therapy:
Patient Preparation: Treatment often requires sedation to keep patients comfortable and still during lengthy procedures. Feeding tubes may be placed to ensure adequate nutrition during recovery periods.
Session Management: Hemodialysis sessions typically last three to five hours and may need to be repeated three times per week for patients with ongoing kidney failure, though single sessions are often sufficient for toxin removal.
Monitoring Protocol: Blood work, heart rate, respiratory rate, temperature and blood pressure are checked regularly to make sure your dog or cat is doing well while receiving treatment.
Prognosis and Recovery Expectations
The podcast addresses realistic expectations for different conditions. For acute kidney injury cases, the initial prognosis is guarded for all cases of AKI, with a mortality rate of approximately 60% (when analyzed across all causes of AKI). However, early intervention with hemodialysis can significantly improve these outcomes.
For toxin cases, prognosis depends heavily on timing. If the animal is presented early enough, hemodialysis can be used to remove the toxin directly from the blood of the pet before it causes any damage. In these situations, complete recovery is often possible.
Dr. Buoncompagni emphasizes that hemodialysis does not treat an injury to the kidney. Hemodialysis helps patients to feel better while the kidneys rest and recover. Additional treatments during hospitalization are essential to address the underlying disease.
Expanding Horizons in Veterinary Medicine
The discussion highlights how extracorporeal therapies are expanding treatment possibilities in veterinary medicine. We are also one of the few hospitals to offer the ability to help infants and small pets, using the CarpediemTM Cardio-Renal Pediatric Dialysis Emergency Machine. This advancement means even very small patients can benefit from these life-saving technologies.
Dr. Buoncompagni’s expertise, gained through hemodialysis certification from the University of California, Davis, and Clinical Fellowship Certification in Urinary Disease & Extracorporeal Therapies from the University of California, San Diego, brings world-class knowledge to veterinary practitioners seeking to understand these complex therapies.
The Importance of Early Recognition and Referral
A key theme throughout the podcast is the critical importance of early recognition and rapid referral for appropriate cases. When it comes to toxins and poisons, time is of the essence. Some toxins and medications can cause damage quickly and treatments need to be performed rapidly before that happens.
Veterinary professionals should maintain a high index of suspicion for cases that might benefit from extracorporeal therapies and establish relationships with referral centers offering these services. Given that dialysis is a complicated, time-consuming, and expensive treatment for dogs and cats, the decision to prescribe treatment is very individualized on a case-by-case basis.
Listen and Learn from the Expert
We strongly encourage listening to the complete episode of “Your Vet Wants You to Know” featuring Dr. Simona Buoncompagni on hemodialysis and extracorporeal therapies. Her detailed explanations of these advanced treatment modalities provide invaluable knowledge for veterinary professionals seeking to expand their understanding of critical care options.
By staying informed about these cutting-edge therapies and understanding when they might benefit our patients, we can make more informed decisions about case management and referral timing. Dr. Buoncompagni’s expertise helps bridge the gap between complex medical technology and practical clinical application, ultimately improving outcomes for our most critically ill patients.
For veterinary professionals interested in learning more about extracorporeal therapies, resources such as the American Society of Veterinary Nephrology and Urology provide additional educational opportunities, including comprehensive training programs in hemodialysis and advanced extracorporeal techniques.
