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Abstract: TH-PO203

Aquapheresis: An Institutional Experience at Lenox Hill Hospital

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Khine, San K., Lenox Hill Hospital, New York, New York, United States
  • Lam, Eric H., NYITCOM , Flushing, New York, United States
  • Dholakia, Kush R., Northwell Health - Lenox Hill Hospital, New York, New York, United States
  • Scheinerman, Samuel Jacob, Lenox Hill Hospital - Northwell Health, New York, New York, United States
  • DeVita, Maria V., Lenox Hill Hospital- Northwell Health System, New York, New York, United States
Background

Aquapheresis (AQ) is the extracorporeal extraction of plasma water from the vascular space across a semipermeable membrane in response to a transmembrane pressure gradient, which efficiently removes extravascular fluid from the patient without compromising electrolytes. It is primarily used in the management of patients (pts) with diuretic resistant heart failure (CHF). AQ is comparable to isolated ultrafiltration (UF) performed on those pts requiring dialysis, but utilizes a machine that is smaller, and easier to operate compared to traditional dialysis equipment. Three major studies on the use of AQ compared to diuretics have shown mixed results: UNLOAD (2007), found that UF produced greater fluid loss and also a 53% reduction in the 90-day rehospitalization; in contrast, in CARRESS-HF (2012), the use of AQ did not relieve CHF and caused worsening of renal function; AVOID (2016), supported the use of AQ to lower re-hospitalization rates in CHF pts. There are no reports of the use of AQ in clinical studies outside of decompensated CHF.

Methods

A retrospective study of AQ utilization at Lenox Hill Hospital, a tertiary care hospital in NYC. Records of pts who received AQ therapy were reviewed. The patient list was generated by searching for keyword “Aquaph” in our EMR. Pts were categorized by indication for AQ and hospital location. Additional information includes duration of treatment (days), changes in creatinine, and total volume removed.

Results

The search generated 28 pts, 5 were excluded as they never actually received AQ. Indications for AQ went into 5 categories: cardiogenic shock including post cardiothoracic procedure (10); anasarca (5); ATN with volume overload (4); ESRD with bridge ultrafiltration between hemodialysis treatments (2); post-op volume overload (2). There were 16 pts from Cardiothoracic ICU, 5 pts from CCU, 1 pt from the Medical ICU and 1 pt from the Surgical ICU. The average duration per patient was 4.26 days. The mean aquapheretic volume per day was 1954 mls, and per encounter was 8323 mls with no significant change in creatinine.

Conclusion

We found that aquapheresis can be safely utilized in situations other than diuretic resistant heart failure. Also to consider, is the ease in which this less complicated aquapheresis machine can be operated compared to the more complex hemodialysis equipment.