{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T13:41:48Z","timestamp":1793367708446,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Vet. Sci.","Veterinary Sciences"],"abstract":"<jats:p>Continuous renal replacement therapy (CRRT) can precipitate anemia in critically ill patients, but temporal hematologic trends and anemia management strategies in cats remain poorly characterized. Medical records of three client-owned cats treated with CRRT for severe acute kidney injury with evidence of pre-existing chronic kidney disease at a single referral center were retrospectively reviewed. Hematologic variables (hematocrit, hemoglobin concentration, absolute reticulocyte count) and renal parameters (blood urea nitrogen, creatinine, phosphorus) were evaluated before, during, and after CRRT, along with the timing of CRRT sessions, whole blood transfusions, erythropoiesis-stimulating agent administration, and adjunctive molidustat use. All three cats demonstrated a progressive decline in hematocrit during the CRRT period despite repeated whole blood transfusions, with only transient post-transfusion improvement. Blood urea nitrogen and creatinine concentrations decreased promptly following CRRT initiation but showed variable rebound patterns during follow-up. Absolute reticulocyte counts increased after CRRT discontinuation in two cats, indicating preserved or recovering erythropoietic activity, while one cat with concurrent inflammatory and infectious disease showed a minimal response. Progressive anemia occurred consistently despite transfusion support, highlighting the multifactorial nature of anemia during feline CRRT. These descriptive findings provide clinically relevant insight into anemia progression during feline CRRT and may inform the design of future prospective studies.<\/jats:p>","DOI":"10.3390\/vetsci13090973","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:07:29Z","timestamp":1789574849000},"page":"973","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hematologic and Renal Trends in Cats Undergoing Continuous Renal Replacement Therapy: A Retrospective Case Series with Molidustat Use"],"prefix":"10.3390","volume":"13","author":[{"given":"Gippeum","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea"},{"name":"Korea Animal Medical Center, Cheongju 28651, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Jeongmin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea"},{"name":"Korea Animal Medical Center, Cheongju 28651, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8478-2035","authenticated-orcid":false,"given":"Kun-Ho","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Veterinary Internal Medicine, College of Veterinary Medicine, Chungnam National University, Daejeon 34134, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.cvsm.2010.09.003","article-title":"Acute kidney injury in dogs and cats","volume":"41","author":"Ross","year":"2011","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0140-6736(11)61454-2","article-title":"Acute kidney injury","volume":"380","author":"Bellomo","year":"2012","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"106548","DOI":"10.1016\/j.tvjl.2026.106548","article-title":"International Renal Interest Society best practice consensus guidelines on the use of continuous renal replacement therapy in dogs and cats","volume":"315","author":"Chen","year":"2026","journal-title":"Vet. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/j.1476-4431.2008.00323.x","article-title":"Use of continuous renal replacement therapy for treatment of dogs and cats with acute or acute-on-chronic renal failure: 33 cases (2002\u20132006)","volume":"18","author":"Diehl","year":"2008","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1177\/1098612X12464460","article-title":"Feline acute kidney injury: 2. Approach to diagnosis, treatment and prognosis","volume":"14","author":"Monaghan","year":"2012","journal-title":"J. Feline Med. Surg."},{"key":"ref_6","first-page":"293","article-title":"Acute kidney injury: Feline focus","volume":"47","author":"Langston","year":"2017","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6556","DOI":"10.1038\/s41598-024-56772-1","article-title":"Impact of anemia requiring transfusion or erythropoiesis-stimulating agents on new-onset cardiovascular events and mortality after continuous renal replacement therapy","volume":"14","author":"Jeon","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"186","DOI":"10.5847\/wjem.j.1920-8642.2023.052","article-title":"Effects of continuous renal replacement therapy on inflammation-related anemia, iron metabolism and prognosis in sepsis patients with acute kidney injury","volume":"14","author":"An","year":"2023","journal-title":"World J. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"F1","DOI":"10.1152\/ajprenal.00174.2010","article-title":"Hypoxic regulation of erythropoiesis and iron metabolism","volume":"299","author":"Haase","year":"2010","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1053\/j.ajkd.2007.03.007","article-title":"Iron management in nondialysis-dependent CKD","volume":"49","author":"Fishbane","year":"2007","journal-title":"Am. J. Kidney Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/tme.12715","article-title":"Erythropoiesis-stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta-analysis","volume":"30","author":"Wijnberge","year":"2020","journal-title":"Transfus. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"P\u00f3rtoles, J., Mart\u00edn, L., Broseta, J.J., and Cases, A. (2021). Anemia in chronic kidney disease: From pathophysiology and current treatments, to future agents. Front. Med., 8.","DOI":"10.3389\/fmed.2021.642296"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/jvim.16827","article-title":"Pharmacodynamic effects of molidustat on erythropoiesis in healthy cats","volume":"38","author":"Boegel","year":"2024","journal-title":"J. Vet. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1111\/jvim.16807","article-title":"Use of molidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, in chronic kidney disease-associated anemia in cats","volume":"38","author":"Charles","year":"2024","journal-title":"J. Vet. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1177\/1098612X14541454","article-title":"Management of acute kidney injury with continuous venovenous haemodiafiltration in a cat","volume":"17","author":"Stanzani","year":"2015","journal-title":"J. Feline Med. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13613-020-00711-6","article-title":"Management and prevention of anemia (acute bleeding excluded) in adult critical care patients","volume":"10","author":"Lasocki","year":"2020","journal-title":"Ann. Intensive Care"},{"key":"ref_17","unstructured":"Reece, W.O., Erickson, H.H., Goff, J.P., and Uemura, E.E. (2015). Dukes\u2019 Physiology of Domestic Animals, Wiley-Blackwell. [13th ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/vec.12363","article-title":"Development of anemia, phlebotomy practices, and blood transfusion requirements in 45 critically ill cats (2009\u20132011)","volume":"26","author":"Balakrishnan","year":"2016","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.cvsm.2010.09.001","article-title":"Continuous renal replacement therapy in dogs and cats","volume":"41","author":"Acierno","year":"2011","journal-title":"Vet. Clin. N. Am. Small Anim. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1111\/j.1939-1676.2008.0063.x","article-title":"A novel clinical scoring system for outcome prediction in dogs with acute kidney injury managed by hemodialysis","volume":"22","author":"Segev","year":"2008","journal-title":"J. Vet. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/j.1939-1676.2006.tb00713.x","article-title":"Characterization of the anemia of inflammatory disease in cats with abscesses, pyothorax, or fat necrosis","volume":"20","author":"Ottenjann","year":"2006","journal-title":"J. Vet. Intern. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"aalaf079","DOI":"10.1093\/jvimsj\/aalaf079","article-title":"Effectiveness and long-term safety of repeated oral administrations of molidustat in the management of anemia associated with chronic kidney disease in cats","volume":"40","author":"Schmidt","year":"2026","journal-title":"J. Vet. Intern. Med."},{"key":"ref_24","first-page":"142","article-title":"Renal replacement therapy and anemia","volume":"178","author":"Clark","year":"2012","journal-title":"Contrib. Nephrol."}],"updated-by":[{"DOI":"10.3390\/vetsci13111170","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:00:00Z","timestamp":1793318400000}}],"container-title":["Veterinary Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-7381\/13\/9\/973\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T10:40:39Z","timestamp":1793356839000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-7381\/13\/9\/973"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":24,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["vetsci13090973"],"URL":"https:\/\/doi.org\/10.3390\/vetsci13090973","relation":{},"ISSN":["2306-7381"],"issn-type":[{"value":"2306-7381","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}