Water treatment-free intermittent hemodialysis: a new approach for kidney replacement therapy in the ICU setting. A retrospective study

Abstract

Abstract The optimal modalities of kidney replacement therapy (KRT) in the ICU remain debated. Intermittent hemodialysis (IHD) and continuous veno-venous hemofiltration (CVVH) are the two main methods. Intermittent hemodialysis requires a water treatment system that may not be available in all jurisdictions. We report the experience of an innovative strategy of intermittent KRT without water treatment system. During the COVID epidemics, the shortage of KRT machines and the transient impossibility of our water treatment system led us to use the Fresenius MultiFiltrate Pro® monitor to achieve IHD in a particular setting. Based on the manufacturer’s recommendations, the dialysate flow during "CVVHDF post" (post-dilution continuous veno-venous hemodiafiltration) mode was increased by connecting the substitution pump in parallel with the dialysate pump using a Y-connector. This allowed doubling the flow rate of dialysate, allowing for 9000 mL/h during intermittent KRT sessions with a blood flow rate of 250 mL/min. We called this technic “water treatment-free intermittent hemodialysis” or WTF-IHD. We report our experience in 18 patients who underwent 88 WTF-IHD sessions (median duration 5 hours (IQR [4;6]) between August 2019 and May 2020. The median urea reduction ratio was 38% (IQR [29;49]). Hypotension occurred during 21.6% of sessions. Hypokalemia or hypophosphatemia occurred in less than 5% of sessions. In conclusion, WTF-IHD represents an attractive alternative to conventional IHD when a water treatment system is not available. Despite its lower efficacy compared with IHD, it may have substantial organizational and economic impact.