Abstract
Background
We automated our manual, syringe-driven extracorporeal renal replacement therapy (eRRT) system with an ultra-small volume circuit (3.2 ml) that is suitable for neonates without blood priming. Our objective was to determine the solute clearance and water balance of the automated and manual systems in vitro.
Methods
Stored whole blood samples containing exogenous urea, creatinine (Cr), potassium (K), and ammonia (NH3) to imitate acute kidney injury (AKI) and hyperammonemia were dialyzed for 3 h (blood flow, 4.0 ml/min; dialysate flow, 600 ml/h) with a continuous infusion of heparin. Solute clearance and sample weight were then compared with values before dialysis.
Results
The median clearance of blood urea nitrogen, Cr, K, and NH3 ranged from 1.7 to 2.3 and from 2.4 to 2.6 ml/min, and the median weight of the samples was decreased by 3.8 g and increased by 8.3 g after 3 h of dialysis using the manual and automated systems, respectively.
Conclusions
The automated system effectively cleared solutes, but safety concerns were associated with platelet consumption and fluid balance. Additional studies are needed to establish the safety and accuracy of this novel system for clinical use in neonates and preterm infants.
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Acknowledgments
We are grateful to the Mother and Child Health Foundation (Grant No. 23–9). We also thank Asahi Kasei Medical Co., Ltd. for supplying the small hemofilters.
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Written informed consent was obtained from all volunteers to participate in this study, which was approved by the Independent Ethics Committee at Iwate Medical University (approval number: H22-33).
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Nishimi, S., Ishikawa, K., Sasaki, M. et al. Ability of a novel system for neonatal extracorporeal renal replacement therapy with an ultra-small volume circuit to remove solutes in vitro . Pediatr Nephrol 31, 493–500 (2016). https://doi.org/10.1007/s00467-015-3233-0
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DOI: https://doi.org/10.1007/s00467-015-3233-0