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. 2021 May 14;2(7):1152-1155.
doi: 10.34067/KID.0000652021. eCollection 2021 Jul 29.

Protocol for Local On-Site Dialysate Production for Continuous Renal Replacement Therapy during the COVID-19 Pandemic

Andrew A Moses  1 , Jacob S Stevens  1   2 , Derek Fine  3 , Robert Carrera  1 , Alina Li  1 , Chirag R Parikh  3 , Sumit Mohan  1   2   4
Affiliations

Protocol for Local On-Site Dialysate Production for Continuous Renal Replacement Therapy during the COVID-19 Pandemic

Andrew A Moses et al. Kidney360. .

Abstract

AKI frequently occurs in patients with COVID-19, and kidney injury severe enough to require RRT is a common complication among patients who are critically ill. During the surge of the pandemic, there was a high demand for dialysate for continuous RRT, and this increase in demand, coupled with vulnerabilities in the supply chain, necessitated alternative approaches, including internal production of dialysate. Using a standard hemodialysis machine and off-the-shelf supplies, as per Food and Drug Administration guidelines, we developed a method for on-site dialysate production that is adaptable and can be used to fill multiple bags at once. The use of a central reverse osmosis unit, dedicated hemodialysis machine, sterile bags with separate ports for fill and use, and frequent testing will ensure stability, sterility, and-therefore-safety of the produced dialysate. The dialysate made in house was tested and it showed both stability and sterility for at least 30 hours. This detailed description of our process for generating dialysate can serve as a guide for other programs experiencing similar vulnerabilities in the demand versus supply of dialysate.

Keywords: COVID-19; continuous kidney replacement; continuous renal replacement therapy; dialysate; dialysate production; dialysis; disaster planning.

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Conflict of interest statement

C.R. Parikh reports having consultancy agreements with Genfit Biopharmaceutical Company; serving as a scientific advisor for, or member of, Genfit Biopharmaceutical Company and RenalytixAI; having ownership interest in RenalytixAI; and receiving research funding from the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). D. Fine reports serving on the medical advisory board for Fresenius Medical Corporation, and having consultancy agreements with GlaxoSmithKline (data and safety monitoring board). S. Mohan reports serving as a member of the Angion Pharma scientific advisory board, as deputy editor for Kidney International Reports (International Society of Nephrology), receiving research funding from Angion Biomedica; receiving research funding from NIH (National Institute of Biomedical Imaging and Bioengineering, National Institute on Minority Health and Health Disparities, and NIDDK). All remaining authors have nothing to disclose.

Figures

Figure 1.
Figure 1.
Schematic figure demonstrating the use of connectors to facilitate filling multiple bags during dialysate production simultaneously.
See this image and copyright information in PMC

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