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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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