Successful management of anuric acute kidney injury associated with aortic thromboembolism with peritoneal dialysis in a cat.

CASE SUMMARY: A 4-year-and-8-month-old, neutered male American Shorthair cat presented with acute hindlimb paralysis and was diagnosed with aortic thromboembolism (ATE) secondary to hypertrophic cardiomyopathy. Despite initial treatment, the cat developed anuric acute kidney injury (AKI), possibly due to ischaemia-reperfusion injury. As referral for haemodialysis was declined, peritoneal dialysis (PD) was initiated using a closed round drainage catheter and manually performed exchanges. Although serum creatinine levels continued to rise during PD, the cat remained clinically stable, and urination resumed on day 8 of PD (day 15 of hospitalisation). The cat was discharged on day 21 with marked improvement in renal parameters and remained stable without recurrence at follow-up.

RELEVANCE AND NOVEL INFORMATION: This case represents a rare report of a cat that developed anuric AKI after ATE and survived to discharge through PD with almost normalised renal values, despite an initial lack of improvement lasting for several days. A number of challenges were encountered, including the lack of standardised feline PD protocols, difficulty in evaluating dialysis efficacy and absence of guidelines for the optimal duration of PD in anuric patients. Despite these limitations, intensive supportive care and continued PD led to favourable clinical outcomes. This case highlights the potential role of PD as a life-saving renal replacement therapy in feline patients with thromboembolism-induced AKI when haemodialysis is unavailable.