Hans-Dietrich Dr. Polaschegg

Continuous Renal Replacement Therapy for End-Stage Renal Disease

Daily dialysis offers many benefits but is difficult to implement. CRRT allows dialysis 24/7 but is not suitable for ESRD patients. Thus, the need for a miniaturized ambulatory CRRT device those patients can wear permanently. We report the feasibility, safety and efficiency in uremic pigs, of such a wearable artificial kidney (WAK) that can be worn as a belt, operated with batteries, and weights less than 5 lbs. We used a hollow fiber dialyzer with a surface area of 0.2 sqm. Dialysate was continuously regenerated by a series of cartridges containing several sorbents allowing the use of approximately 375 ml of dialysate. The device includes reservoirs with heparin and electrolytes. Average fluid removal was 100 ml/hr. The Creatinine was 25 ml/min. In 8 hrs the total Creatinine removed was 1 gr, Urea 12 gr, P0.8 gr and K 72 mEq. Weekly st kt/v was extrapolated to approximately 7. There were no side effects. The WAK can be operated safely and continuously 168 hr/week. This would allow for all the advantages of daily dialysis and reduce morbidity and mortality in the ESRD population. It will also reduce cost and manpower utilization.

Technical Aspects of Online Hemodiafiltration

The chapter describes and analyzes the most commonly used systems for online substitution fluid production in hemofiltration and hemodiafiltration, covering in detail systems comprising 2 multiuse filters, or 2 multiuse filters in combination with 1 disposable filter. A generally applicable risk analysis for the process of online substitution fluid preparation is provided. It is concluded that both system variants discussed perform in a safe manner, provided the operator fully complies with the manufacturers instructions for use.

Wearable Dialysis: What is Missing?

In this chapter, unanswered questions regarding the safety and usability of the wearable artificial kidney (WAK) are discussed. This will cover issues such as safe blood access, risks related to the operation of the WAK, temporary disconnection or separation during sleep, and reloading dialysate regeneration cartridges.