Pre dialysis of blood prime in continuous hemodialysis normalizes pH and electrolytes

Abstract

In critically ill children weighing <10 kg, it is necessary to use blood as a priming solution for the extracorporeal continuous renal replacement therapy (CRRT) circuit before initiating CRRT to prevent hemodilution and maintain adequate oxygenation. However, blood bank blood usually contains supra-physiological electrolyte concentrations and a non-physiological acid-base balance that may exacerbate the patient's condition. The objective of this trial was to develop a simple protocol to pre-treat blood bank-derived blood to yield a more physiological blood priming solution. Expired human blood in a recirculating in vitro CRRT circuit was dialyzed prior to the initiation of CRRT using a physiological dialysate solution. Serial blood samples were assessed for electrolyte and pH content. Regimens using maximal blood flow rates (180-200 ml/min) and aggressive dialysate flow rates (33-42 ml/min) were able to correct severely hyperkalemic and acidemic blood within 7.5 min. Initially elevated blood potassium concentrations >20 mEq/l were normalized to below 5 mEq/l within 7.5 min of dialysis in all cases. Blood bank-derived blood can be "conditioned" quickly to physiological pH and electrolyte concentrations using these simple pre-dialysis regimens. Unlike some blood preparation regimens that have been published, the technique used in this trial requires no special equipment or added medications that are not already used in CRRT.

Daptomycin Clearance during Modeled Continuous Renal Replacement Therapy

“…The in vitro CRRT model used in the present study has been used successfully to determine solute clearance by CVVH and CVVHD [15][16][17]29] . Urea is not significantly protein bound, consequently a SC and SA of ϳ 1 would be expected and was achieved in the present study.…”

“…The daptomycin transmembrane clearances by continuous hemofiltration and continuous hemodialysis techniques were assessed using an in vitro, bovine blood model developed in our laboratory [15][16][17] . The CRRT model used 1 liter of pH regulated, bovine blood (Animal Technologies, Tyler, Tex., USA) anticoagulated with 3.8% sodium citrate, placed in an Erlenmeyer flask which was submerged in a 37 ° C water bath.…”

Evaluation and Management of Acute Kidney Injury in Children

“…The BRS leads to a range of mild to profound hypotension. Several methods of mitigating BRS have been published in children, including normalizing the blood pH and giving a calcium bolus to the patient to counter the citrate in the blood unit as well as performing pre-dialysis of blood used to prime the circuit in smaller children [144,145].…”

Innovative Techniques to Decrease Blood Exposure and Minimize Interruptions in Pediatric Continuous Renal Replacement Therapy

“…6,15,[21][22][23] A large, rapid infusion of citrated, hyperkalemic banked donor blood typically results in significant hemodynamic compromise, as well as acid base and electrolyte imbalances. 14,15,21,24 Even hyperkalemichypocalcemic cardiac arrests at the initiation of blood-primed circuits in children have been reported. 25 Although all patients are at risk for these complications, small children and infants are at greater risk because a larger portion of their blood volume is exchanged.…”