| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 22077 | 22077 | 22077 |
| Full Text Views | 83 | 83 | 83 |
| PDF Downloads | 12 | 12 | 12 |
Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children with Severe Malaria-Associated Acute Kidney Injury
Rebecca Coriolan
Rebecca Coriolan
Department of Pediatrics, Hassenfeld Children’s Hospital at New York University, New York, New York;
Search for other papers by Rebecca Coriolan in
Current site
Google Scholar
PubMed
Search for other papers by Rebecca Coriolan in
Current site
Google Scholar
PubMed
Apaara Chawla
Apaara Chawla
George Washington University, Washington, District of Columbia;
Search for other papers by Apaara Chawla in
Current site
Google Scholar
PubMed
Search for other papers by Apaara Chawla in
Current site
Google Scholar
PubMed
Jolyn Morgan
Jolyn Morgan
Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Search for other papers by Jolyn Morgan in
Current site
Google Scholar
PubMed
Search for other papers by Jolyn Morgan in
Current site
Google Scholar
PubMed
Amanda Snyder
Amanda Snyder
Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Search for other papers by Amanda Snyder in
Current site
Google Scholar
PubMed
Search for other papers by Amanda Snyder in
Current site
Google Scholar
PubMed
James Rose
James Rose
Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Search for other papers by James Rose in
Current site
Google Scholar
PubMed
Search for other papers by James Rose in
Current site
Google Scholar
PubMed
Giovanni Ceschia
Giovanni Ceschia
Department for Women’s and Children’s Health, University Hospital of Padua, Padua, Italy;
Search for other papers by Giovanni Ceschia in
Current site
Google Scholar
PubMed
Search for other papers by Giovanni Ceschia in
Current site
Google Scholar
PubMed
Gianna Zangri
Gianna Zangri
Dialysis Without Borders, San Diego, California;
Search for other papers by Gianna Zangri in
Current site
Google Scholar
PubMed
Search for other papers by Gianna Zangri in
Current site
Google Scholar
PubMed
Andrea L. Conroy
Andrea L. Conroy
Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;
Search for other papers by Andrea L. Conroy in
Current site
Google Scholar
PubMed
Search for other papers by Andrea L. Conroy in
Current site
Google Scholar
PubMed
Anthony Batte
Anthony Batte
Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
Search for other papers by Anthony Batte in
Current site
Google Scholar
PubMed
Search for other papers by Anthony Batte in
Current site
Google Scholar
PubMed
Stuart L. Goldstein
Stuart L. Goldstein
Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;
Search for other papers by Stuart L. Goldstein in
Current site
Google Scholar
PubMed
Search for other papers by Stuart L. Goldstein in
Current site
Google Scholar
PubMed
Denise C. Hasson
denise.hasson@nyulangone.org
Denise C. Hasson
Department of Pediatrics, Hassenfeld Children’s Hospital at New York University, New York, New York;
Search for other papers by Denise C. Hasson in
Current site
Google Scholar
PubMed
Search for other papers by Denise C. Hasson in
Current site
Google Scholar
PubMed
Acute kidney injury (AKI) remains a common cause of preventable death in low-resource settings because of cost and lack of dialysis access. AKI occurs in 24–59% of children with severe malaria, and when severe malaria-associated acute kidney injury (SM-AKI) is complicated by hyperkalemia, mortality approaches 40%. Treatment of these children with severe anemia becomes challenging as packed red blood cells (pRBCs) have high potassium (K+) loads. We describe a protocol using the novel manual single-lumen alternating microbatch (mSLAMB) dialysis system to deplete pRBCs of K+, hypothesizing that this system can decrease K+ >80% in 20 minutes. Herein, we ran pRBC aliquots through the mSLAMB system using diffusive clearance. Three cycles were completed in each of four experiments. K+ was measured at baseline and after every cycle to calculate K+ reduction. Active ultrafiltration was performed to control net volumes, assessed as percentage of blood volume reduction and hematocrit rise. We reduced K+ in pRBC aliquots by a median of 93.2% (interquartile range [IQR], 89.9–95.1) in a median of 20.5 minutes (IQR, 17.8–23.1) per experiment. Greatest median K+ reduction occurred in cycle 1 (80.9%; IQR, 80.8–80.9), with minimal additional clearance achieved by cycle 3. Median hematocrit rise at experiment conclusion was 2.5% (IQR, 1.8–3.3). We conclude that mSLAMB dialysis consistently and effectively removed >80% of K+ from pRBCs in just over 20 minutes and facilitated volume control. Further studies are assessing transfusion risks in children with SM-AKI and hyperkalemia as this technique may allow for safer resuscitation.
Author Notes
Financial support: There was no financial support for this project. Stavro Medical supplied manual single-lumen alternating microbatch kits and dialyzers free of charge. They played no part in the study design, data collection, analysis, interpretation, or writing of the report.
Disclosures: J. Morgan is a consultant for Medtronic. A. Snyder is a consultant for Medtronic. S. L. Goldstein reports receiving personal fees from Baxter Healthcare, BioPorto Inc., Nuwellis, Fresenius, MediBeacon, and Medtronic. The remaining authors have no disclosures or conflicts of interest to report.
Authors’ contributions: R. Coriolan, A. Chawla, J. Morgan, A. Snyder, A. L. Conroy, A. Batte, G. Zangri and D. Hasson conceived, designed, and performed the experiments and data acquisition. R. Coriolan and D. Hasson performed data analysis and interpretation and were primary manuscript authors. J. Rose performed laboratory techniques that allowed for data acquisition. G. Ceschia, A. L. Conroy, A. Batte, and S. L. Goldstein provided critical article drafting and editing.
Current contact information: Rebecca Coriolan and Denise C. Hasson, Hassenfeld Children’s Hospital at New York University, New York, NY, E-mails: rebecca.coriolan@nyulangone.org and denise.hasson@nyulangone.org. Apaara Chawla, George Washington University, Washington, DC, E-mail: apaarachawla@gmail.com. Jolyn Morgan, Amanda Snyder, James Rose, and Stuart L. Goldstein, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, E-mails: jolyn.morgan@cchmc.org, amanda.snyder@cchmc.org, james.rose@cchmc.org, and stuart.goldstein@cchmc.org. Giovanni Ceschia, University Hospital of Padua, Padua, Italy, E-mail: gio.ceschia@gmail.com. Gianna Zangri, Dialysis Without Borders, San Diego, CA, E-mail: giannamary21@gmail.com. Andrea L. Conroy, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN, E-mail: conroya@iu.edu. Anthony Batte, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda, E-mail: abatte@iu.edu.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 22077 | 22077 | 22077 |
| Full Text Views | 83 | 83 | 83 |
| PDF Downloads | 12 | 12 | 12 |