Novel use of premixed dialysate bags during water supply interruption in acute hospital setting

Abstract

Dialysis patients are exposed to large amounts of water during conventional intermittent hemodialysis (IHD) hence strict regulations exist for the quality of water used to prepare dialysate. Occasionally water systems fail due to natural disasters or structural supply issues such as water main breaks or unplanned changes in municipal or facility water quality. It is critical to regularly monitor and immediately recognize such a failure and take steps to avoid exposing the patients to contaminants. In addition to the recognition of the problem, the ability to pivot and continue to provide safe treatment to dialysis dependent inpatients is essential both from ultrafiltration and clearance standpoint. At our hospital, an unforeseen water disruption occurred and we were able to continue to provide renal replacement therapy with pre-made bagged dialysate to mitigate the impact on our dialysis patients. This is a novel method in utilizing available machines and dialysate, which we normally stock for continuous renal replacement therapy, for short dialysis sessions. The methodology is similar to that which has been widely used for short daily home hemodialysis with low dialysate flow rate. As this situation occurred in the midst of the Sars CoV2 pandemic we had to be mindful of dialysate volumes as well as staffing time. Here we present our investigation into the cause of water system failure and how we quickly implemented the alternative dialysis method. Short dialysis with low flow dialysate will not deliver the same Kt/V per session as standard dialysis, however it was successful as implemented and tailored with adjustments for patients requiring higher clearance for specific indication such as severe hyperkalemia.