ECC Suggested Readings
August 2025
Adesola Odunayo DVM, MS, DACVECC
Adesola Odunayo grew up in Lagos, Nigeria, and moved to Norman, Oklahoma in 1999. She earned her Doctor of Veterinary Medicine degree from Oklahoma State University before completing a residency in Emergency and Critical Care at the University of Missouri. She is currently a faculty member at the University of Florida, where she enjoys taking care of critically ill dogs and cats while also contributing to teaching and research. Outside of work, she loves exploring the world’s many wonders and shares her home with two dogs and two cats.
A paper that I recently liked…
Case report: use of pleural dialysis as an alternate means of renal replacement therapy in three cats
Vernier ME, Fick ME, Johnson TE, Ueda Y, Vigani A
Paper Commentary
Case Report
I was excited to read this paper as it highlights a novel approach that could expand renal replacement therapy (RRT) options for cats (and potentially dogs) with severe azotemia. This case series reports three feline patients in which traditional extracorporeal therapies, such as intermittent hemodialysis (IHD), were unavailable or impractical, leading clinicians to explore pleural dialysis as an alternative. This procedure was previously described in dogs in 1985 but has not been commonly used in veterinary patients. This is not a recognized medical procedure in people.
Pleural dialysis utilizes the pleural cavity and membrane as a semi-permeable surface for solute and fluid exchange, functioning similarly to peritoneal dialysis. Like the peritoneum, the pleura consists of a mesothelial surface, basement membrane, and vascularized interstitium, which allow for diffusion and ultrafiltration. Compared to peritoneal dialysis, pleural dialysis may offer more predictable filling and drainage, while avoiding complications seen with peritoneal dialysis such as peritonitis, impaired diaphragmatic movement, or catheter obstruction by omentum. It may also serve as an option when the peritoneum cannot be used, for example, in cases of abdominal trauma, peritonitis, or the presence of post-surgical adhesions.
In the 3 cats in this case series, a central venous catheter (CVC) was placed into the pleural space. Dialysate (Plasmalyte 148 with 5% dextrose and potassium chloride at 0.05 mEq/kg/h) was instilled through one lumen, while the second lumen served as the outflow line. An initial dwell time of 30 minutes was used, and inflow rates were calculated based on the patient’s urea reduction ratio. Catheter kinking or clogging occurred intermittently but was resolved with adjustments or flushing, though one catheter ultimately became non-functional. Effective reduction in urea concentrations occurred in all 3 cats following pleural dialysis, and the procedure was well tolerated without major complications. Two cats survived to discharge, while the third was euthanized due to poor prognosis unrelated to the dialysis itself.
This case series introduces pleural dialysis as a safe and feasible, though still experimental, form of RRT in cats. Careful risk-benefit evaluation is essential before making recommendations for this intervention and further research is needed to define complication rates, outcomes, and broader applicability. Nonetheless, pleural dialysis represents a promising therapeutic option, particularly where access to IHD or other extracorporeal methods is limited.
