Dialysis in disaster: Using continuous renal replacement therapy for end-stage renal disease patients, a pilot proof of concept study

Introduction: Each dialysis session uses approximately 150 to 200 L of water. The winter stormthat swept south-west USA saw an unprecedented disruption of water supplies due to which intermittent hemodialysis could not be performed for end-stage renal disease (ESRD) patients. We present 4 cases when continuous renal replacement therapy (CRRT) was utilized to provide urgent hemodialysis in hemodynamically stable, non-critically ill ESRD patients during this time of water supply crisis. Case presentation: Our patients were between the ages 47-62 years old, mostly male. Indications for urgent hemodialysis included volumeoverloadwith pulmonary edema and respiratory distress, hypertensive crisis, refractory hyperkalemia, and uremic encephalopathy. The CRRT equipment used included the PRISMAX system for CRRT with M150 filters. Continuous veno-venous hemodialysis (CVVHD) more was used with a dialysate flow rate of 6 L /hour and a blood flowrate of 200/per hourwith calculated urea clearance of 100 mL/min. The duration of treatment was 8 h to achieve the target Kt/V of 1.15, comparable to the recommended 1.2 provided by IHD. All patients tolerated the procedure well with the resolution of their acute conditions and normalization of blood pressure and electrolytes. Conclusion: We demonstrate limited CRRT as an alternative to safely manage ESRD patients needing urgent hemodialysis in the scenario of a natural disaster resulting in a water outage. (c) 2022 Elsevier Inc. All rights reserved.