Diversifying aquapheresis in critical care: An institutional experience

Volume overload is a frequent complication in critically ill patients. Ultrafiltration (UF) uses a semipermeable membrane for removal of plasma water driven by a transmembrane pressure gradient. Employed outside dialysis, it is referred to as aquapheresis (AQ). This study is a retrospective review of our experience with AQ beyond management for congestive heart failure (CHF). The use of AQ was at the discretion of the nephrologist overseeing the case. The study population was categorized according to hospital unit and specific indications for AQ therapy. A total of 69 patients underwent AQ in various critical units: 23 in the cardiothoracic intensive care unit (ICU); 21 in both the cardiac ICU and medical ICU, and 4 patients in the surgical ICU. All patients had a component of kidney dysfunction and volume overload, ranging from non-oliguric acute kidney injury to end-stage renal disease (ESRD). The average UF volume was 6.4 L per patient, with an UF rate of 82 mL/h. The mean AQ duration was 78 hours per patient. 64% (n = 44), were receiving vasopressor support during AQ. Volume optimization remains a fundamental component of management in critically ill patients. AQ can be employed as an additional resource to accelerate fluid removal in a myriad of clinical settings. This analysis underscores the versatility of AQ as an effective treatment for managing fluid overload across diverse patient populations.