Emergency Production and Collection of Dialysate for CVVHD During the COVID-19 Pandemic

Abstract

T he pandemic of Coronavirus disease 2019 (COVID19) has resulted in a significant increase in the need for kidney replacement therapy due to the high incidence of acute kidney injury, with early reports claiming an incidence rate of 40% to 50% in critical care patients. To limit the exposure to health care workers, continuous kidney replacement therapy modalities, such as continuous veno-venous hemodialysis (CVVHD), are preferred, as these approaches can be administered by nursing staff and do not require dedicated dialysis personnel. However, lack of preparedness for pandemics and supply shortages of dialysate fluid have severely limited the ability of health care providers to deliver sufficient kidney replacement therapy for patients severely affected by COVID-19. We interacted with multiple health care providers who reported shortages in dialysate for CVVHD, and providers outside the Johns Hopkins health care system who were preparing backup plans for their depleting reserves as cases continued to increase. At the time, the solutions were limited to rationing strategies, including the reduction of treatment time, decreasing dialysate flow rate, or using noncommercial supplies of dialysate. In this report, we share our methodology and design for a simple, open-source 3D printed adapter that enables production and collection of dialysate for CVVHD using a Fresenius 2008T hemodialysis machine, a Fresenius Optiflux high-flux dialyzer (Fresenius, Bad Homburg, Germany) and a Baxter Exactamix total parenteral nutrition (TPN) bag (Baxter, Deerfield, Illinois, USA). The method is easily adaptable to any conventional hemodialysis (HD) machine, dialyzer, and sterile collection bag.