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

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 patients^6,7 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.