How to Advise Your Pet Lovers on Home Dialysis

This blog post was made by Beth Witten, MSW, ACSW, LSCSW on June 29, 2022.
How to Advise Your Pet Lovers on Home Dialysis

Do you work with people who have pets and do home dialysis or are thinking about it? Whether you are a pet lover or can't imagine having any pet, it's important to share accurate, evidence-based facts about the benefits and risks of living with pets while doing PD or home HD.

Some people on dialysis have one or more pets because of their love of animals. Others have pets to help them do things as a service animal or for emotional support. Asking someone who needs dialysis to give up their pet is not necessary—as long as they know how to stay as safe as possible from injuries an animal can cause or diseases an animal can spread.

The CDC reports that studies have shown that having a pet can increase one's exercise level and improve socialization. In older adults, the increased exercise and socialization can help cognitive function. Having a pet has been shown to improve blood pressure, cholesterol and triglyceride levels and reduce loneliness, anxiety, and PTSD symptoms.1

At the same time, whether someone is on dialysis or not, it's important for a pet owner to recognize that a big dog can knock them over, while a small animal running freely in the home can be a tripping hazard. All animals take time and money for food, supplies, regular checkups, and emergency vet care. All animals need to be fed regularly. Some animals, like dogs and horses, need a yard or field in which to potty and exercise. That area must be contained to prevent them from running away or scaring or harming someone. Cages for birds and small animals and aquariums for fish and reptiles must be cleaned regularly. A pet owner needs to do all of these things no matter how s/he feels.

Estimates hold that almost two-thirds of households in the U.S. have some kind of pet:

  • Dogs (69 million)

  • Cats (45.3 million)

  • Freshwater fish (11.8 million)

  • Bird (9.9 million)

  • Small animals (6.2 million)

  • Reptiles (5.7 million)

  • Horses (3.5 million)

  • Saltwater fish (2.9 million)

People cannot get some animal diseases like feline immunodeficiency virus (FIV), feline leukemia, feline herpes or canine influenza. But anyone can get the following diseases from pets.2

Disease Animal How to avoid or treat
Rabies Dogs, cats Vaccinate. Keep pets inside or don't let them run wild outside.
Toxoplasmosis Cat feces or animal feces in garden Change litter daily. Ask another to change litter. Or, wear gloves and wash hands after handling litter or gardening.
Cat Scratch Disease Cats Avoid getting scratched. Wash scratches with soap and water. Don't let a cat lick open wounds. See an MD if infected.
Hookworm, Roundworm Dog, cat Wash hands after contact with a dog or cat. Wear shoes outside and gloves to garden. Get dogs or cats dewormed.
Tapeworm Dog, cat, or contaminated food Treat pets for fleas. Seek treatment if you see rice-like larvae in stool.
Ringworm (a ring-shaped red scaly fungal rash) Dog, cat, horse, other animals, and humans, or contaminated surfaces If a pet has ringworm, get vet care and keep it off your bed. If a person has it, wash sheets and pajamas daily, and seek MD care if extensive.
Salmonella Reptiles, chicks, ducks, dogs, cats, birds, horses, contaminated food Wash hands with soap and water after touching reptiles or animal feces. Don't touch reptiles, chicks, or ducklings if your immune system is weak.
Parrot Fever Parrots, parakeet, macaw, cockatiel (infection not obvious) Don't buy sick a bird (with eye or nasal drainage, diarrhea, low weight). Change cage paper daily. Disinfect cage regularly with bleach solution. Set up cage in a ventilated area. Take a sick bird to the vet. See MD for flu-like or respiratory symptoms.
Lyme Disease Ticks from dogs or outside cats In spring/summer, avoid areas with ticks. Use vet-approved tick prevention on pets. Spray DEET insect repellant on body and clothing in tick areas. Wear light-colored long sleeves/pants when hiking. Remove ticks ASAP with paper towel and plastic bag. Avoid crushing, which can release bacteria.

Staying Safe on Dialysis When You Have Pets

Those on dialysis need to know how to stay safe on dialysis with pets. Most peritonitis in those on PD is caused by Staphylococcus aureus or coagulase negative Staphylococcus epidermidis. However, cases of peritonitis from Pasteurella multocida have been diagnosed in those on PD who have dogs and cats 3 P multocida is present in 70-90% of cats and 20-50% of dogs, and can be found in other animals as well. Those with diabetes or kidney disease/failure who have weakened immune systems may be at greater risk of infection, which can cause bacteremia, meningitis, and endocarditis4 as well as peritonitis. There is at least one case of an HD patient who died from this infection after his dog licked his neck where he had a central venous catheter.5 Another bacteria found in the mouths of dogs and cats, Capnocytophaga canimorsus, has caused sepsis in a few HD patients6,7 and peritonitis in PD patients.8 A PD patient got peritonitis caused by Aeromonas hydrophila because he didn't wash his hands well enough after cleaning his goldfish tank.9 Handwashing with soap and water can go a long way to prevent infection from pets and from other environmental contaminants. If there's one thing we've learned from living through a pandemic, it's to wash our hands with soap and water often, and this would apply whether you have a pet or not.

Advising dialysis patients not to let a dog or cat lick them is reasonable, but patients may not follow your advice. It is important for patients to keep pets away from dialysis equipment to avoid damage and to keep pets that might bite, scratch or peck away from HD or PD tubing. Dialysis clinics advise patients to keep their pets out of the dialysis room when doing a manual PD exchange or connecting or disconnecting from a PD cycler. Finally, for patients doing home HD, securing needles is especially important, as is protecting the access site. Those who like to dialyze with pets on their laps need to be aware of the risk of needle dislodgement which might occur if their pet when startled suddenly jumps off their lap and catches a foot or collar in their dialysis lines. That could damage the access, cause blood loss, and result in a big mess to clean up.

Conclusion

Studies show that having a pet provides clinical and emotional benefits for those on dialysis. At the same time, studies have also shown there is an increase in the risk of infection, especially in those with weakened immune systems, like those with diabetes and those on dialysis. Patients with pets need to be made aware of the risks so they can protect themselves from infection, hospitalization or worse.


  1. Centers for Disease Control and Prevention. How to stay healthy around pets. https://www.cdc.gov/healthypets/keeping-pets-and-people-healthy/how.html (accessed 6/19/2022)↩︎

  2. Fetch by WebMD. Diseases You Can Get from Your Pets: Worms, rabies and More. https://pets.webmd.com/diseases-you-can-get-from-your-pets (accessed 6/19/2022)↩︎

  3. Aboulhosn AZ, Takele RA, Laflam PF. Unusual Pathogen in a Patient With Peritoneal Dialysis-Related Peritonitis: A Case Report. Cureus. 2022 Apr 8;14(4):e23948. doi: 10.7759/cureus.23948. PMID: 35535290; PMCID: PMC9080286. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9080286/pdf/cureus-0014-00000023948.pdf (accessed 6/19/2022)↩︎

  4. Hasan J, Hug M. Pasteurella Multocida. https://www.ncbi.nlm.nih.gov/books/NBK557629/↩︎

  5. Boinett C, Gonzalez A. Pasteurella multocida septicaemia in a patient on haemodialysis Case Reports 2009;2009:bcr0120091492. https://casereports.bmj.com/content/2009/bcr.01.2009.1492 (accessed 6/19/2022)↩︎

  6. Mori J, Oshima K, Tanimoto T. Cat Rearing: A Potential Risk of Fulminant Sepsis Caused by Capnocytophaga canimorsus in a Hemodialysis Patient. Case Rep Nephrol Dial. 2020 May 13;10(2):51-56. doi: 10.1159/000507425. PMID: 32518766; PMCID: PMC7265706. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265706/pdf/cnd-0010-0051.pdf (accessed 6/19/2022)↩︎

  7. Oluyombo R, Tsiouli E, Gunda SS. Case report of Capnocytophaga canimorsus septicemia with infective endocarditis in a hemodialysis patient: A not widely known dog pathogen. Hemodial Int. 2021 Mar 18. doi: 10.1111/hdi.12917. Epub ahead of print. PMID: 33738954. https://pubmed.ncbi.nlm.nih.gov/33738954/↩︎

  8. Tanabe K, Okamoto S, Hiramatsu Asano S, Wada J. Capnocytophaga canimorsus peritonitis diagnosed by mass spectrometry in a diabetic patient undergoing peritoneal dialysis: a case report. BMC Nephrol. 2019 Jun 14;20(1):219. doi: 10.1186/s12882-019-1415-x. PMID: 31200664; PMCID: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570874/pdf/12882_2019_Article_1415.pdf ↩︎

  9. Hisamichi M, Yokoyama T, Yazawa M, Kaneshiro N, Sakurada T, Konno Y, Shibagaki Y, Yasuda T, Kimura K. A rare case of peritoneal dialysis-related peritonitis caused by goldfish water tank derived aeromonas hydrophila. Clin Nephrol. 2015 Jul;84(1):50-4.↩︎

Comments

  • Beth Witten

    Jul 03, 2022 10:38 PM

    Thank you, Theodor, for this reference. The "ISPD peritonitis guideline recommendations:
    2022 update on prevention and treatment" is a 44-page document. It includes a section on Domestic Pet and Zoonotic Infection with these recommendations on page 118:
    * We recommend PD patients take extra precautions to prevent peritonitis if domestic pets are kept (1C).
    * We suggest pets not be allowed in the room where PD exchange takes place, and where dialysis tubing, equipment and machine are stored (2A)

    See https://journals.sagepub.com/doi/pdf/10.1177/08968608221080586
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  • Theodôr

    Jul 01, 2022 8:19 AM

    First my congrats Beth on taking this topic forward.
    I just gave a presentation last week during our national annual renal conference on home dialysis and the role of the carers, hygiene and domestic pets. As a renal social worker the balance in Quality of Life can be dependant on the presence of a domestic pet. For that we do not block homedialysis therapies but do press on te importance of knowledge on the risks and how to avoid those. Because of the potent threat which is carried in the faeces, urine, skin and mouth flora of pets this needs to be properly addressed.
    I have personally seen the devastation of Capnocytofaga Canimorsus in renal patients and this was horrifying. But the dangers are not only due to this "beast"; As Beth noted severa ones all kinds of bacteria, virusses, fungi, yeasts and (intestinal) parasytes. So this topic needs dire attention! The latest ISPD Peritoneal Dialysis guideline specifically wrote down a section handling this issue which I pasted for you below! With all the above in mind I know that in taking care of the proper precautions life on dialysis with domestic pets is possible and can enhance the QoL for both patient and those closest to them....be it spouse and family members ...and the pets involved ;-)
    Cheers Theodôr

    ISPD peritonitis guideline recommendations:2022 update on prevention and treatment
    Philip Kam-Tao Li et al, Peritoneal Dialysis International 2022, Vol. 42(2) 110–153

    Domestic pet and zoonotic infection
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