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Kidney Week

Abstract: PO0861

Use of Tablo Hemodialysis Systems to Extend Dialytic Capabilities for the COVID-19-Associated Surge of AKI

Session Information

Category: Coronavirus (COVID-19)

  • No subcategory defined

Authors

  • Goldfarb, David S., NYU Langone Health, New York, New York, United States
  • Yan, Jessica M., VA New York Harbor Healthcare System, New York, NY, New York, United States
  • Gross, Matthew A., VA New York Harbor Healthcare System, New York, NY, New York, United States
  • Block, Clay A., Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, United States
Background

The COVID-19 pandemic was associated with a greater incidence of AKI than expected. At the NY Harbor VA we faced an overwhelming number of AKI patients who were critically ill with multi-organ failure. We needed to invoke new mechanisms of providing kidney replacement therapy (KRT).

Methods

We obtained 3 Tablo systems in late March, 2019. The machines have self-contained reverse osmosis capabilities and so do not require other equipment to operate. They can make dialysate from concentrate and tap water and so do not require special plumbing adaptation. Their self-contained step-by-step procedures are relatively simple to follow and allow rapid training of previously unskilled personnel. Tablo generates 300 ml dialysate per minute, and blood flow was increased to up to 400 ml/min as tolerated.

Results

Training was completed by 2 nephrologists and 2 RNs without previous dialysis experience. We used the Tablo Hemodialysis System to provide KRT to critically ill patients. In the first week we demonstrated that water cultures and endotoxin testing were negative, and that AAMI water tests were acceptable. We used the machines to provide KRT for ICU patients with double-lumen dialysis catheters. In addition we used the machines on hospital wards where KRT had not been provided before because of a lack of the plumbing needs of conventional HD machines. We provided multiple treatments 3-6 times per week for 15 AKI patients, mean age 65 years. The mean of the best urea reduction ratio achieved in the first 1-4 treatments, if available, was 41% (often limited by hypotension and fulfillment of ultrafiltration, UF, needs). Most treatments were successful and were slowed for hypotension or tachycardia. Some were aborted because of water pressure alarms if sediment filters needed replacement, or lines clotted due to hypercoagulability associated with COVID-19. Personnel availability dictated that most treatments were 3-4 hours (and up to 8h), and generally achieved UF goals. Later HD nurses cannulated arteriovenous fistulas in ESKD patients and left treatment to non-HD nurses to complete.

Conclusion

By incorporating a user-friendly platform and an accelerated training program including nephrologists and RNs without previous dialysis experience, we were able to nearly double our capacity to deliver KRT during the surge.

Funding

  • Veterans Affairs Support