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Manual single lumen alternating micro-batch dialysis achieves reliable clearance via diffusion

Pediatric Research volume 94, pages 1335–1340 (2023)Cite this article

Abstract

Background

Acute kidney injury is a cause of preventable deaths in low resource settings due to lack of dialysis access and cost. A manual single lumen alternating micro-batch (mSLAMB) dialysis technique performs kidney replacement therapy using single lumen access, low-cost bags/tubing, intravenous fluids, and a filter without electricity, a battery, or a pump. We propose a protocol whereby mSLAMB can perform diffusive clearance simply and efficiently to bring dialysis to underserved populations.

Methods

Expired packed red blood cells mixed with crystalloid solution were spiked with urea and anticoagulated with heparin. A Static diffusion Technique (with short flushes of fluid before each filter pass) was compared to a Dynamic diffusion Technique (with fluid running through the filter during the forward pass) to assess urea and potassium clearance. Passive ultrafiltration was the difference between the 200 mL batch volume and volume returned to the blood bag per cycle.

Results

Five cycles achieved urea reduction ratios (URR) between 17–67% and potassium clearance of 18–60%, with higher percentages achieved from higher proportions of batch volume dialyzed to patient volume. Dynamic Technique increased clearance over the Static Technique. Passive ultrafiltration volumes were 2.5–10% of batch volume.

Conclusion

mSLAMB dialysis performs diffusive clearance and passive ultrafiltration efficiently, while preserving resources and available manpower.

Impact

  • mSLAMB is a dialysis technique that can perform efficient diffusive clearance and passive ultrafiltration without electricity, batteries, or a pump.

  • With basic medical supplies and limited manpower, mSLAMB is a cost-effective means of providing emergency dialysis in low resource areas.

  • We propose a basic algorithm for safe and cost-effective dialysis for people of different ages and sizes.

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Fig. 1: Suggested mSLAMB dynamic technique configuration.
Fig. 2: Mean urea reduction ratio and potassium clearance rate.
Fig. 3: Blood reservoir height difference determines blood flow rate.
Fig. 4: Simplified mSLAMB Dynamic Technique algorithm.

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Data availability

All data generated or analyzed during this study are available from the corresponding author who will gladly make available all data on reasonable request.

References

  1. Mehta, R. L. et al. International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 385, 2616–2643 (2015).

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Acknowledgements

We thank Dr. Lakhmir Chawla for his editorial assistance in the development of this manuscript. mSLAMB kits and dialyzers were donated by Stavro Medical, Inc.

Author information

Authors and Affiliations

  1. Department of Women’s and Children’s Health, University of Padua, Padua, Italy

    Giovanni Ceschia

  2. Francis Parker High School, San Diego, CA, USA

    Apaara K. Chawla

  3. Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Jolyn Morgan & Stuart L. Goldstein

  4. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    James E. Rose & Stuart L. Goldstein

  5. Division of Pediatric Critical Care Medicine, Hassenfeld Children’s Hospital at NYU Langone Health, New York, NY, USA

    Denise C. Hasson

Authors
  1. Giovanni Ceschia
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  2. Apaara K. Chawla
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  3. Jolyn Morgan
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  4. James E. Rose
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  5. Stuart L. Goldstein
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  6. Denise C. Hasson
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Contributions

G.C., A.K.C., J.M., and D.C.H. all conceived, designed, and performed experiments and data acquisition. G.C. and D.C.H. performed data analysis, interpretation, and were primary manuscript authors. J.R. performed laboratory techniques that allowed for data acquisition. S.L.G. provided critical article drafting and editing.

Corresponding author

Correspondence to Denise C. Hasson.

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Competing interests

S.L.G. reports receiving personal fees from Baxter Healthcare, BioPorto Inc., Nuwellis, Fresenius, MediBeacon, and Medtronic. J.M. is a consultant for Medtronic.

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Ceschia, G., Chawla, A.K., Morgan, J. et al. Manual single lumen alternating micro-batch dialysis achieves reliable clearance via diffusion. Pediatr Res 94, 1335–1340 (2023). https://doi.org/10.1038/s41390-023-02636-9

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  • DOI: https://doi.org/10.1038/s41390-023-02636-9

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