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Continuous kidney replacement therapy (CKRT) is often utilized to stabilize patients with severe acute kidney injury associated with significant electrolyte abnormalities and/or oliguria and concomitant fluid accumulation. Circuit downtime may reduce daily treatment time and affect delivered doses of CKRT. Studies have found clotting to be the leading cause of downtime and underdosing, which are associated with negative treatment outcomes. The NxStage Cartridge Express with Speedswap (NxStage Medical, Inc.) was designed to minimize downtime by allowing filter priming to occur in parallel with ongoing CKRT and by permitting filter exchanges without the need to replace the entire cartridge. Data from pilot studies suggest that filter exchanges using this system interrupt treatment by an average of 4 minutes per exchange-a considerable reduction from traditional systems that require treatment to be discontinued while the filter is primed, which can take 30 minutes or more. In addition to increasing patient time on therapy, this system has the potential to reduce costs for patients who require a high number of filter changes, and reduce nursing labor and environmental impact (reduced plastic waste). Future studies should confirm whether patients at higher risk of clotted/clogged filters benefit from CKRT with a system designed for rapid filter changes.

Sean Loughlin What new developments are we seeing in terms of dialysis-related technology?Danilo Concepcion Companies are beginning to incorporate features such as blood volume monitoring for fluid management and biofeedback. The Centers for Medicare & Medicaid Services (CMS) is looking at fluid management as part of its quality initiative. Denny TreuWe probably are going to see more integrated systems that include water treatment, which will improve ease of use, quality, and safety. Other forthcoming technologies are going to the result in increased water purity.Joseph Pulliam We will begin to see more online monitoring for chlorine and other items, which will remove some of the potential for human errors. Sean Loughlin In terms of biomedical technicians with a focus on dialysis: Do we have enough, and are they adequately trained?Danilo Concepcion Although we have dedicated biomeds who are focused on dialysis, the level of experience and qualifications may not be adequate for the responsibility. With no mandate for certification or qualification for the technology staff aspect in dialysis, the qualifications and educational background for individuals filling the role for equipment support is left to the facility. Some facilities have taken clinical staff and have moved them to the technology support or even required from these staff dual roles of doing patient care and technology support. We have not formalized the qualifications for biomeds in the dialysis industry, compared with the formality that they have within the hospital environment.Jo-Ann Maltais I agree with Danilo. I sit on the National Nephrology Certification Organization Board of Directors, so I see information on the types of individuals who take the certification exams. To Danilo's point, many of them come from the patient care side and are unable to pass the biomedical nephrology technology exam on the first try. Furthermore, dialysis biomedical technicians do not receive adequate training. Part of that could be solved by pursuing certification, but there's not sufficient motivation it seems. Certification is not required by CMS for the biomeds, whereas it is for the patient care techs. Many of the companies and providers don't support their technicians in taking the exam, so there really isn't any motivation for the individuals to increase their technical training. Sean Loughlin Are there other thoughts on why dialysis technicians are undertrained?Danilo Concepcion From my perspective, the manufacturers of dialysis equipment have done an excellent job of simplifying maintenance and repair, so you don't always need a