“Machineless” Nutritional Hemodialysis

Abstract

It was previously demonstrated that with nutritional hemodialysis (NH), an adaptation of continuous arteriovenous hemodialysis (CAVHD), glucose and aminoacids are efficiently transferred from the dialysate to the patient. Intravenous monitors were used to control dialysate flow and ultrafiltration, and a water manometer provided fail-safe operation. Pressure measurements with low flux dialyzers indicated that a gravity system was possible. This observation formed the basis for the current study. Nutrient dialysate was prepared by adding glucose and amino acid to a bicarbonate dialysate. Subsequently, the bicarbonate dialysate was eliminated by reducing the dialysate volume and increasing the glucose concentration. Dialysate flow was controlled with a valve postdialyzer, and ultrafiltration adjusted by varying the height of the dialysate container. At a glucose concentration of 14.4 gm/dl and outflow rate of 3.9 ml/min, 97% of the glucose in the dialysate was transferred to the patient. Compared with intravenous nutrition, NH is as easy to perform, less costly, does not provide fluid, and is inherently fail-safe. As no equipment is required, many patients can be treated simultaneously. "Machineless" NH suggests the possibility of machineless CAVHD, which could provide dialysis and parenteral nutrition to many acute renal failure patients after a major disaster.