Manual single lumen alternating micro-batch dialysis achieves reliable clearance via diffusion

Area of Science:

• Nephrology
• Biomedical Engineering
• Public Health

Background:

• Acute kidney injury (AKI) is a significant cause of preventable mortality in low-resource settings, largely due to limited access to and high costs associated with dialysis.
• Existing dialysis methods often require electricity, batteries, or pumps, posing significant barriers in underserved regions.

Purpose of the Study:

• To introduce and evaluate a novel manual single lumen alternating micro-batch (mSLAMB) dialysis technique.
• To demonstrate the feasibility of mSLAMB for diffusive clearance and ultrafiltration in resource-limited environments.
• To propose a protocol for implementing mSLAMB in areas lacking standard dialysis infrastructure.

Main Methods:

• The mSLAMB technique was tested using expired packed red blood cells spiked with urea and anticoagulated with heparin.
• Two diffusion techniques (Static and Dynamic) were compared for urea and potassium clearance.
• Passive ultrafiltration was measured as the difference between batch volume and returned volume per cycle.

Main Results:

• Five cycles of mSLAMB achieved urea reduction ratios (URR) of 17-67% and potassium clearance of 18-60%.
• The Dynamic diffusion technique demonstrated superior clearance compared to the Static technique.
• Passive ultrafiltration volumes ranged from 2.5% to 10% of the batch volume.

Conclusions:

• The mSLAMB dialysis technique effectively performs diffusive clearance and passive ultrafiltration, conserving resources and manpower.
• mSLAMB offers a cost-effective solution for emergency dialysis in low-resource areas, requiring only basic medical supplies and minimal personnel.
• A basic algorithm for safe and cost-effective mSLAMB dialysis across different patient demographics is proposed.