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Abstract
INTRODUCTION The standard of care for refractory hyperkalemia is renal replacement therapy (RRT). However, traditional RRT requires specialized equipment, trained personnel, and large amounts of dialysate. It is therefore poorly suited for austere environments. We hypothesized that a simplified hemoperfusion system could control serum potassium concentration in a swine model of acute hyperkalemia. METHODS Ten pigs were anesthetized and instrumented. A dialysis catheter was inserted. After bilateral nephrectomy, animals received intravenous potassium chloride and were randomized to the control or treatment group. In both groups, blood was pumped through an extracorporeal circuit (EC) with an in-line hemodialyzer. In the treatment arm, ultrafiltrate from the hemodialyzer was diverted through cartridges containing novel potassium binding beads and returned to the EC. Blood samples were obtained every 30 min for 6 h. RESULTS Serum potassium concentration was significantly lower in the treatment than in the control group over time (P = 0.02). There was no difference in serum total calcium concentration for group or time (P = 0.13 and 0.44, respectively) or platelet count between groups or over time (P = 0.28 and 1, respectively). No significant EC thrombosis occurred. Two of five animals in the control group and none in the treatment group developed arrhythmias. All animals survived until end of experiment. CONCLUSIONS A simplified hemoperfusion system removed potassium in a porcine model. In austere settings, this system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT.
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Clemens MS, Stull MC, Rall JM, Stewart IJ, Sosnov JA, Chung KK, Ross JD. Extracorporeal Filtration of Potassium in a Swine Model of Bilateral Hindlimb Ischemia-Reperfusion Injury With Severe Acute Hyperkalemia. Mil Med 2019; 183:e335-e340. [PMID: 30137515 DOI: 10.1093/milmed/usy189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/19/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Options for the treatment of hyperkalemia in the pre-hospital setting are limited, particularly in the context of natural disaster or during combat operations. Contemporary interventions require extensive resources and technical expertise. Here we examined the potential for a simple, field deployable bridge-dialysis as a countermeasure for acute hyperkalemia induced by prolonged ischemia-reperfusion. Methods Twenty female swine were randomized into two experimental groups undergoing a 2-hour bilateral hindlimb ischemia-reperfusion injury. Subsequent to injury, hemoperfusion was performed in the presence (Column) and absence (Sham Control) of a high-affinity potassium-binding column (CytoSorbents, Monmouth Junction, NJ, USA). Serial blood gas and chemistries were sampled. Primary endpoint was changed in serum potassium concentrations post-injury and filtration. Results Serum potassium was significantly elevated following ischemia-reperfusion injury in both groups (149% (12) and 150% (22), p < 0.05 vs respective baseline values). There were no differences observed between groups in respect to physiologic parameters; mean arterial pressure, heart rate, systemic vascular resistance, cardiac output, or central venous oxygenation. Filtration resulted in a significant relative decrease in potassium compared with controls after the first hour as determined by repeated measures two-way ANOVA (p < 0.0001) which continued through end of the study. Significant thrombocytopenia was observed in animals undergoing filtration with a mean reduction in platelets measured at T = 480 minutes (168 × 103μL, p < 0.0001 vs baseline). Conclusions We demonstrate that serum potassium can be filtered via hemoperfusion utilizing a simple extracorporeal potassium-binding platform, though evolution of this technology will be required to achieve meaningful reduction of potassium in clinically significant hyperkalemia after trauma.
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Affiliation(s)
- Michael S Clemens
- Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.,San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX
| | - Mamie C Stull
- Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.,San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX
| | - Jason M Rall
- San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX
| | - Ian J Stewart
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, 101 Bodin Cir, Fairfield, CA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Jonathan A Sosnov
- San Antonio Military Medical Center, Joint Base San Antonio, 3551 Roger Brooke Dr, San Antonio, TX.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD
| | - Kevin K Chung
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD.,United States Army Institute for Surgical Research, Joint Base San Antonio, 3698 Chambers Rd, San Antonio, TX
| | - James D Ross
- Office of the Chief Scientist, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio, 2200 Bergquist Dr, San Antonio, TX.,Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Rd, Portland, OR
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