The Brophy Kit: A Manual Hemodialysis Device for Neonates

Authors

Giovanni Ceschia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Cara L. Slagle, Indiana University, Riley Hospital for Children, Indianapolis, Indiana, USA.
Jolyn Morgan, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Amanda Snyder, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
James E. Rose, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Ed Plute, ExThera Medical, Martinez, California, USA.
Apaara K. Chawla, George Washington University, Washington, District of Columbia, USA.
Rebecca Coriolan, New York University Langone Health, New York, New York, USA.
Danielle E. Soranno, Indiana University, Riley Hospital for Children, Indianapolis, Indiana, USA.
Stuart L. Goldstein, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Denise C. Hasson, New York University Langone Health, New York, New York, USA.

Document Type

Journal Article

Publication Date

2-1-2025

Journal

Kidney international reports

Volume

10

Issue

2

DOI

10.1016/j.ekir.2024.11.026

Keywords

AKI; extremely low birth weight neonates; kidney replacement therapy; manual dialysis; neonatal kidney failure; single lumen dialysis

Abstract

INTRODUCTION: Acute kidney injury (AKI) is common in critically ill neonates, including very and extremely low birth weight (VLBW, ELBW) neonates. In severe cases, kidney replacement therapy (KRT) may be warranted. Currently, available KRT devices are only indicated for those weighing ≥ 2.5 kg and require a double lumen or 2 separate single lumen catheters. We miniaturized the Kirpa Kit manual dialysis device, naming it the Brophy Kit, and we assessed its in vitro clearance and ultrafiltration (UF) performance. METHODS: We diluted packed red blood cells to a normal hematocrit (Hct: 31.1%-36.8%) and conducted 12 clearance and 3 UF experiments. A cycle consisted of aspirating 10 ml of blood from the blood bag, passing it through a hemofilter, and returning it in a circular path. For clearance experiments, we tested 4 configurations, with varied timing and volume of saline flushes to refresh the dialysis compartment, then measured blood urea nitrogen (BUN) and potassium concentrations every 5 cycles. For each UF cycle, 1 ml of ultrafiltrate was removed, and Hct was measured every 10 cycles. RESULTS: Median BUN and potassium reduction were 31.0% (interquartile range [IQR]: 17.6-37.9) and 35.0% (IQR: 26.9-41.7), respectively, after 30 clearance cycles. Median Hct increased to 52.6% (IQR: 52.5-53.8) after 60 UF cycles, more than the expected Hct (47.7%). CONCLUSION: The Brophy Kit performs in vitro clearance efficiently and UF consistently. The Brophy Kit may address a technological KRT gap for small neonates because of its minimal extracorporeal volume and ability to function with single lumen access.

APA Citation

Ceschia, Giovanni; Slagle, Cara L.; Morgan, Jolyn; Snyder, Amanda; Rose, James E.; Plute, Ed; Chawla, Apaara K.; Coriolan, Rebecca; Soranno, Danielle E.; Goldstein, Stuart L.; and Hasson, Denise C., "The Brophy Kit: A Manual Hemodialysis Device for Neonates" (2025). GW Authored Works. Paper 6645.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/6645

Department

School of Medicine and Health Sciences Student Works