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Improvised Field Expedient Method for Renal Replacement Therapy in a Porcine Model of Acute Kidney Injury

Published online by Cambridge University Press:  02 June 2020

Guillaume L. Hoareau Open the ORCID record for Guillaume L. Hoareau [Opens in a new window] ,
Carl A. Beyer ,
Harris W. Kashtan ,
Lauren E. Walker ,
Christopher Wilson ,
Andrew Wishy ,
J. Kevin Grayson  and
Ian J. Stewart
Guillaume L. Hoareau*
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA University of Utah Health, Emergency Medicine Division, Salt Lake City, UT
Carl A. Beyer
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA Department of Surgery, University of California Davis Medical Center, Sacramento, CA
Harris W. Kashtan
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA Department of Surgery, University of California Davis Medical Center, Sacramento, CA
Lauren E. Walker
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA
Christopher Wilson
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA
Andrew Wishy
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA Department of Surgery, University of California Davis Medical Center, Sacramento, CA
J. Kevin Grayson
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA
Ian J. Stewart
Affiliation:
David Grant USAF Medical Center, Travis Air Force Base, CA Uniformed Services University of the Health Sciences, Bethesda, MD
*
Correspondence and reprint requests to Guillaume L. Hoareau, University of Utah Health, Division of Emergency Medicine, 30 N. 1900 E, Room 1C26, Salt Lake City, UT 84132 (e-mail: [email protected]).
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Abstract

Objective:

Dialysis patients may not have access to conventional renal replacement therapy (RRT) following disasters. We hypothesized that improvised renal replacement therapy (ImpRRT) would be comparable to continuous renal replacement therapy (CRRT) in a porcine acute kidney injury model.

Methods:

Following bilateral nephrectomies and 2 hours of caudal aortic occlusion, 12 pigs were randomized to 4 hours of ImpRRT or CRRT. In the ImpRRT group, blood was circulated through a dialysis filter using a rapid infuser to collect the ultrafiltrate. Improvised replacement fluid, made with stock solutions, was infused pre-pump. In the CRRT group, commercial replacement fluid was used. During RRT, animals received isotonic crystalloids and norepinephrine.

Results:

There were no differences in serum creatinine, calcium, magnesium, or phosphorus concentrations. While there was a difference between groups in serum potassium concentration over time (P < 0.001), significance was lost in pairwise comparison at specific time points. Replacement fluids or ultrafiltrate flows did not differ between groups. There were no differences in lactate concentration, isotonic crystalloid requirement, or norepinephrine doses. No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions.

Conclusion:

The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters.

Keywords

crush syndromedialysisdisaster medicineextracorporeal blood purificationtemporary dialysis
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 15 , Issue 6 , December 2021 , pp. 741 - 749
Copyright
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc.

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References

REFERENCES

Erek, E, Sever, MS, Serdengecti, K, et al. An overview of morbidity and mortality in patients with acute renal failure due to crush syndrome: the Marmara earthquake experience. Nephrol Dial Transplant. 2002;17(1):33–40.CrossRefGoogle ScholarPubMed
Anderson, AH, Cohen, AJ, Kutner, NG, et al. Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina. Kidney Int. 2009;75(11):1202–1208.CrossRefGoogle ScholarPubMed
Kleinpeter, MA. Disaster preparedness of dialysis patients for Hurricanes Gustav and Ike 2008. Adv Perit Dial. 2009;2562–2567.Google ScholarPubMed
Portilla, D, Shaffer, RN, Okusa, MD, et al. Lessons from Haiti on disaster relief. Clin J Am Soc Nephrol. 2010;5(11):2122–2129.CrossRefGoogle ScholarPubMed
Bonomini, M, Stuard, S, Dal Canton, A. Dialysis practice and patient outcome in the aftermath of the earthquake at L’Aquila, Italy, April 2009. Nephrol Dial Transplant. 2011;26(8):2595–2603.CrossRefGoogle Scholar
He, Q, Wang, F, Li, G, et al. Crush syndrome and acute kidney injury in the Wenchuan earthquake. J Trauma. 2011;70(5):1213–1217.Google ScholarPubMed
Vanholder, R, Borniche, D, Claus, S, et al. When the earth trembles in the Americas: the experience of Haiti and Chile 2010. Nephron Clin Pract. 2011;117(3):c184–197.CrossRefGoogle ScholarPubMed
Lin, CJ, Pierce, LC, Roblin, PM, Arquilla, B. Impact of Hurricane Sandy on hospital emergency and dialysis services: a retrospective survey. Prehosp Disaster Med. 2014;29(4):374–379.CrossRefGoogle ScholarPubMed
Murakami, N, Siktel, HB, Lucido, D, et al. Disaster preparedness and awareness of patients on hemodialysis after Hurricane Sandy. Clin J Am Soc Nephrol. 2015;10(8):1389–1396.CrossRefGoogle ScholarPubMed
Hill, The. Thousands with kidney disease at risk in Puerto Rico. http://thehill.com/policy/healthcare/353174-thousands-with-kidney-disease-at-risk-in-puerto-rico. Published October 1, 2017. Accessed June 14, 2018.Google Scholar
Stewart, IJ, Tilley, MA, Cotant, CL, et al. Association of AKI with adverse outcomes in burned military casualties. Clin J Am Soc Nephrol. 2012;7(2):199–206.CrossRefGoogle ScholarPubMed
Zonies, D, DuBose, J, Elterman, J, et al. Early implementation of continuous renal replacement therapy optimizes casualty evacuation for combat-related acute kidney injury. J Trauma Acute Care Surg. 2013;75(2 Suppl 2):S210–S214.CrossRefGoogle ScholarPubMed
Bolanos, JA, Yuan, CM, Little, DJ, et al. Outcomes after post-traumatic AKI requiring RRT in United States military service members. Clin J Am Soc Nephrol. 2015;10(10):1732–1739.CrossRefGoogle ScholarPubMed
Heegard, KD, Stewart, IJ, Cap, AP, et al. Early acute kidney injury in military casualties. J Trauma Acute Care Surg. 2015;78(5):988–993.CrossRefGoogle ScholarPubMed
Stewart, IJ, Sosnov, JA, Howard, JT, Chung, KK. Acute kidney injury in critically injured combat veterans: a retrospective cohort study. Am J Kidney Dis. 2016;68(4):564–570.CrossRefGoogle ScholarPubMed
Vanholder, R, Gibney, N, Luyckx, VA, Sever, MS. Renal Disaster Relief Task Force in Haiti earthquake. Lancet. 2010;375(9721):1162–1163.CrossRefGoogle ScholarPubMed
Rifai, AO, Murad, LB, Sekkarie, MA, et al. Continuous venovenous hemofiltration using a stand-alone blood pump for acute kidney injury in field hospitals in Syria. Kidney Int. 2015;87(2):254–261.CrossRefGoogle ScholarPubMed
Kellum, JA, Lameire, N, Aspelin, P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1–138.Google Scholar
Hoareau, GL, Beyer, C, Walker, L, et al. Renal replacement therapy capability for the treatment of combat associated acute kidney injury: a historical perspective to plan for future conflicts. Mil Med. 2019;184(3-4):81–83.CrossRefGoogle ScholarPubMed
Gorbatkin, C, Bass, J, Finkelstein, FO, et al. Peritoneal dialysis in austere environments: an emergent approach to renal failure management. West J Emerg Med. 2018;19(3):548–556.CrossRefGoogle ScholarPubMed