Aluminum kinetics using bicarbonate dialysate with the sorbent system

Area of Science:

• Nephrology
• Biomedical Engineering
• Materials Science

Background:

• The REDY system utilizes a sorbent cartridge to regenerate hemodialysate, significantly reducing dialysate volume requirements.
• Manufacturer claims suggest the sorbent cartridge removes aluminum without adding it to the dialysate, with existing data primarily supporting acetate dialysate.
• Limited data exists regarding the REDY system's performance with bicarbonate dialysate concerning aluminum kinetics.

Purpose of the Study:

• To evaluate the aluminum removal capabilities of the REDY system's sorbent cartridge with bicarbonate dialysate.
• To assess aluminum kinetics in vitro and in vivo using bicarbonate dialysate in the REDY system.
• To determine the safety and efficacy of the REDY system in managing aluminum levels during hemodialysis.

Main Methods:

• In vitro analysis of the sorbent cartridge's ability to remove aluminum from prepared dialysate.
• In vivo crossover study comparing the REDY system with single-pass dialysis for plasma aluminum concentrations.
• Second in vivo study evaluating the effect of tap water-derived dialysate on plasma aluminum using the predialysis purification procedure.

Main Results:

• In vitro, the sorbent cartridge reduced dialysate aluminum from 470 µg/L to below 10 µg/L, with initial effluent aluminum decreasing post-filtration.
• In vivo studies showed no significant differences in pre- and post-plasma aluminum concentrations, with dialysate aluminum consistently below 4 µg/L.
• The REDY system demonstrated effective aluminum control, comparable to previous findings and suitable for hemodialysis applications.

Conclusions:

• The REDY system's sorbent cartridge effectively removes aluminum from bicarbonate dialysate, meeting safety standards for hemodialysis.
• Discarding the initial effluent is unnecessary as filterable aluminum is minimal and does not pass through dialysis membranes.
• The REDY system provides a safe and effective method for managing aluminum levels in hemodialysis patients using bicarbonate dialysate.