Retrospective Evaluation of the Indications, Complications, and Outcomes of Extracorporeal Therapies in Companion Animals in a Veterinary Teaching Hospital.

ECT complications are common but manageable; intoxication and leptospirosis-associated AKI carry the best survival outcomes.

This retrospective case series evaluated the indications, complications, and outcomes of extracorporeal therapies (ECT) in 41 companion animals (37 dogs, 4 cats) treated at a single veterinary university teaching hospital between November 2023 and December 2024. ECT modalities included hemodialysis (HD), hemoperfusion (HP), and therapeutic plasma exchange (TPE), administered across 103 total sessions for endogenous substance accumulation (primarily acute kidney injury [AKI]), immune-mediated disease (IMD), and intoxication. Session-level complications were common overall (HD: 27%, HP: 71%, TPE: 64%), with circuit clotting, hypocalcemia, bleeding, and hemodynamic instability being most frequent; no complications were fatal. HD demonstrated a significantly lower complication rate compared to other modalities (p = 0.012). Overall, 25 of 41 animals were discharged, and 20 of 25 survived to 1-month follow-up. Survival differed significantly by indication in dogs: intoxication carried a 100% survival rate, AKI 57%, and IMD 33% (p = 0.006). Among AKI cases, dogs with probable or confirmed leptospirosis had notably better 1-month survival (9/19) compared to those with other AKI etiologies (1/4) (p = 0.014). These findings suggest ECT is a viable but technically demanding treatment modality in veterinary patients. While complications are frequent, most are manageable and non-fatal. Intoxication cases treated with ECT carry an excellent prognosis, and leptospirosis-associated AKI appears more responsive to ECT than other AKI causes.

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