Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children with Severe Malaria-Associated Acute Kidney Injury

Authors

Rebecca Coriolan, Department of Pediatrics, Hassenfeld Children's Hospital at New York University, New York, New York.
Apaara Chawla, George Washington University, Washington, District of Columbia.
Jolyn Morgan, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Amanda Snyder, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
James Rose, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Giovanni Ceschia, Department for Women's and Children's Health, University Hospital of Padua, Padua, Italy.
Gianna Zangri, Dialysis Without Borders, San Diego, California.
Andrea L. Conroy, Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
Anthony Batte, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda.
Stuart L. Goldstein, Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Denise C. Hasson, Department of Pediatrics, Hassenfeld Children's Hospital at New York University, New York, New York.

Document Type

Journal Article

Publication Date

4-8-2025

Journal

The American journal of tropical medicine and hygiene

DOI

10.4269/ajtmh.24-0756

Abstract

Acute kidney injury (AKI) remains a common cause of preventable death in low-resource settings because of cost and lack of dialysis access. AKI occurs in 24-59% of children with severe malaria, and when severe malaria-associated acute kidney injury (SM-AKI) is complicated by hyperkalemia, mortality approaches 40%. Treatment of these children with severe anemia becomes challenging as packed red blood cells (pRBCs) have high potassium (K+) loads. We describe a protocol using the novel manual single-lumen alternating microbatch (mSLAMB) dialysis system to deplete pRBCs of K+, hypothesizing that this system can decrease K+ >80% in 20 minutes. Herein, we ran pRBC aliquots through the mSLAMB system using diffusive clearance. Three cycles were completed in each of four experiments. K+ was measured at baseline and after every cycle to calculate K+ reduction. Active ultrafiltration was performed to control net volumes, assessed as percentage of blood volume reduction and hematocrit rise. We reduced K+ in pRBC aliquots by a median of 93.2% (interquartile range [IQR], 89.9-95.1) in a median of 20.5 minutes (IQR, 17.8-23.1) per experiment. Greatest median K+ reduction occurred in cycle 1 (80.9%; IQR, 80.8-80.9), with minimal additional clearance achieved by cycle 3. Median hematocrit rise at experiment conclusion was 2.5% (IQR, 1.8-3.3). We conclude that mSLAMB dialysis consistently and effectively removed >80% of K+ from pRBCs in just over 20 minutes and facilitated volume control. Further studies are assessing transfusion risks in children with SM-AKI and hyperkalemia as this technique may allow for safer resuscitation.

APA Citation

Coriolan, Rebecca; Chawla, Apaara; Morgan, Jolyn; Snyder, Amanda; Rose, James; Ceschia, Giovanni; Zangri, Gianna; Conroy, Andrea L.; Batte, Anthony; Goldstein, Stuart L.; and Hasson, Denise C., "Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children with Severe Malaria-Associated Acute Kidney Injury" (2025). GW Authored Works. Paper 7085.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7085

Department

School of Medicine and Health Sciences Student Works