Evaluation of a powerless portable dialysate generator in a porcine model of continuous renal replacement therapy

Introduction Polytrauma is often characterised by rhabdomyolysis, hyperkalaemia and renal failure, which is treated with acute haemodialysis. Transport and storage of dialysate are expensive and cumbersome and require space that may be unavailable in resource-limited scenarios. We examined a portable, powerless dialysate generator in a porcine model of continuous renal replacement therapy (CRRT). Methods Anaesthetised swine (n=12) underwent bilateral nephrectomy and placement of a haemodialysis catheter. Intravenous potassium and urea were infused, and animals received CRRT with either a dialysate solution prepared with tap water through a novel portable dialysate generator (PDG) or commercially available dialysate (CAD, NxStage). Both groups were dialysed with a NxStage System One through an in-line haemodialysis filter at typical flow rates. Blood samples were drawn hourly during 6hours of CRRT. Results There were no differences in conductivity between PDG and CAD (p=0.31), as well as no detected arsenic, lead, mercury or free chlorine in the PDG dialysate produced. After 6hours of CRRT, total effluent fluid was 10.09±0.18L and 10.04±0.30L in the PDG and CAD groups, respectively (p=0.89). Urea reduction ratio was similar in the two groups (p=0.39), as were serum levels of potassium (p=0.87). All animals survived until the end of CRRT. Conclusions A PDG machine using potable water created dialysate of similar efficacy as commercial prepackaged dialysate in a porcine CRRT model. The generated dialysate may obviate transport and storage of large quantities of dialysate in a resource-limited combat or natural disaster environments.