Hemoperfusion for veterinary toxicities: International renal interest society best practices consensus guidelines

New adsorptive devices for hemoperfusion are available in veterinary medicine for the management of toxin exposures and life-threatening toxin decontamination. This document is offered as the currently recommended standard-of-care and best practice guidelines derived from the clinical experiences of experts treating toxicities with hemoperfusion. Much of the evidence available to support recommendations on extracorporeal management of veterinary intoxications is limited, inconsistent, indirect, or of poor quality. Consequently, a formal consensus methodology which relies heavily on expert opinion was used to validate the proposed guidelines of the International Renal Interest Society's (IRIS) Hemoperfusion Study Group. An independently selected voting panel of noted authorities in veterinary extracorporeal medicine were charged to vote and comment on each Study Group recommendation in isolation and without supplemental rationale. To achieve consensus, a minimum of 75 % of the voting participants chose "strongly agree" or "agree" compared to neutral or disagree responses. As this is a rapidly evolving therapeutic modality, and the technologies are changing with similar pace, we expect these clinical guidelines will also evolve rapidly. It will be important to review updates from the manufacturers of hemoperfusion devices to obtain the most current treatment recommendations for specific adsorptive devices.