Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children...

Area of Science:

• Nephrology
• Pediatrics
• Hematology

Background:

• Acute kidney injury (AKI) is a major cause of preventable death in resource-limited settings, particularly in children with severe malaria.
• Severe malaria-associated AKI (SM-AKI) with hyperkalemia significantly increases mortality risk.
• Transfusing packed red blood cells (pRBCs) to treat severe anemia in these patients is complicated by high potassium loads.

Purpose of the Study:

• To evaluate the efficacy of a novel manual single-lumen alternating microbatch (mSLAMB) dialysis system for depleting potassium (K+) from pRBCs.
• To determine if the mSLAMB system can reduce K+ levels in pRBCs by over 80% within 20 minutes.
• To assess the system's ability to control volume during the K+ depletion process.

Main Methods:

• pRBC aliquots were processed through the mSLAMB system using diffusive clearance in three cycles.
• Potassium levels were measured at baseline and after each cycle to calculate K+ reduction.
• Active ultrafiltration was employed to manage net volumes, with blood volume reduction and hematocrit rise as indicators.

Main Results:

• The mSLAMB system reduced K+ in pRBC aliquots by a median of 93.2% in a median of 20.5 minutes.
• The greatest K+ reduction (median 80.9%) occurred during the first cycle, with minimal additional clearance in subsequent cycles.
• A median hematocrit rise of 2.5% was observed, indicating effective volume control.

Conclusions:

• The mSLAMB dialysis system efficiently and consistently removes over 80% of K+ from pRBCs in approximately 20 minutes.
• The system also provides effective volume control during the process.
• This technique holds promise for enabling safer blood transfusions in children with SM-AKI and hyperkalemia.