NO WATER, NO PROBLEM: USING CRRT FOR HEMODIALYSIS PATIENTS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Each dialysis session uses approximately 150 to 200 L of water [1]. While this was an issue discussed by policymakers and environmentalists, the winter storm that swept across southwest United States in February 2021 made bedside physician keenly aware problem. The region saw unprecedented disruption power supplies which put end-stage renal disease (ESRD) patients jeopardy. Intermittent hemodialysis (IHD) could not be performed due lack running water, low pressures, unsanitary conditions. We present 4 cases when continuous replacement therapy (CRRT) utilized provide urgent hemodynamically stable, non-critically ill ESRD during time supply crisis. CASE PRESENTATION: Our were between ages 47-62 years old, mostly male. All on IHD three days per week. Shortness breath presenting complaint 3 patients, each whom had missed their last scheduled HD inclement weather. 1 presented with altered mental status. Indications for included volume overload pulmonary edema respiratory distress, hypertensive crisis, refractory hyperkalemia, uremic encephalopathy. CRRT equipment used PRISMAX system M150 filters. Renal solution containing 32 mEq/L bicarbonate, potassium, 2.5 calcium as dialysate fluid. Continuous veno-venous (CVVHD) more a flow rate 6L /hour blood 200/per hour calculated urea clearance 100 ml/min. duration treatment 8 hours achieve target Kt/V 1.15, comparable recommended 1.2 provided IHD. 9-10 bags session. Fluid removal ranged from 150-500 ml/hr. patient required repeat subsequent day incomplete filter clotting. tolerated procedure well resolution acute conditions normalization pressure electrolytes. developed brief hypotension resolved fluid administration. No other adverse events seen. DISCUSSION: has typically been critically patients. It requires specialized higher nurse: ratio compared but can manage electrolyte derangements without substantial requirements CONCLUSIONS: demonstrate limited alternative safely needing scenario natural disaster resulting outage. REFERENCE #1: Hoenich NA, Levin R, Ronco C: Water haemodialysis related therapies: recent standards emerging issues. Blood Purif 2010;29:81–8 DISCLOSURES: relevant relationships Sukhmani Boparai, source=Web Response Scientific Advisor relationship ALung Technologies, Inc. Please note: $5001 - $20000 Steven Conrad, Response, value=Consulting fee Rajkamal Hansra, Prathik Krishnan, Audrey Netzel,