Dataset Information

The Production, Efficacy, and Safety of Machine-Generated Bicarbonate Solution for Continuous Venovenous Hemodialysis (CVVHD): The Cleveland Clinic Method.

ABSTRACT:

Rationale & objective

Since 1994, the Nephrology and Hypertension Department at the Cleveland Clinic has prepared and used bicarbonate-based solution for continuous venovenous hemodialysis (CVVHD) using a standard volumetric hemodialysis machine rather than purchasing from a commercial vendor. This report describes the process of producing Cleveland Clinic UltraPure Solution (CCUPS), quality and safety monitoring, economic costs, and clinical outcomes.

Study design

Retrospective study.

Setting & participants

CVVHD experience at Cleveland Clinic, focusing on dialysate production, institutional factors, and patients requiring continuous kidney replacement therapy. Production is shown at www.youtube.com/watch?v=WGQgephMEwA.

Outcomes

Feasibility, safety , and cost.

Results

Of 6,426 patients treated between 2011 and 2019 with continuous kidney replacement therapy, 59% were men, 71% were White, 40% had diabetes mellitus, and 74% presented with acute kidney injury. 98% of patients were treated with CVVHD using CCUPS, while the remaining 2% were treated with either continuous venovenous hemofiltration or continuous venovenous hemodiafiltration using commercial solution. The prescribed and delivered effluent doses were 24.8 (IQR) versus 20.7 mL/kg/h (IQR), respectively. CCUPS was as effective in restoring electrolyte and serum bicarbonate levels and reducing phosphate, creatinine, and serum urea nitrogen levels as compared with packaged commercial solution over a 3-day period following initiation of dialysis, with a comparable effluent dose. Among those with acute kidney injury, mortality was similar to that predicted with the 60-day acute kidney injury predicted mortality score (r = 0.997; CI: 0.989-0.999). At our institution, the cost of production for 1 L of CCUPS is $0.67, which is considerably less than the cost of commercially purchased fluid.

Limitations

Observational design without a rigorous control group.

Conclusions

CVVHD using locally generated dialysate is safe and cost-effective.

SUBMITTER: Taliercio JJ

PROVIDER: S-EPMC8178460 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:Hemodialysis is one of major stresses in patients' daily lives since there is no other path for life maintenance but to accept the machine and its' related rules.of this study was to explore factors associated with dependency on dialysis machine as reported by the patients.The sample of the study included 250 patients undergoing hemodialysis. For data collection a questionnaire specially designed for the needs of the research was used. More specifically, socio-demographic and clinical characteristics as well as several other self-reported variables were collected.Of the 250 participants, 53.2% was men while 65.2% was aged over 60 years. The study showed that 44% of the patients reported that their life depended very much on hemodialysis machine. Statistically significant association was observed between dependency on dialysis machine as reported by the patients and gender (p=0.030), education (p=0.022), job (p=0.001) and place of residence (p=0.001). Additionally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and the degree of information about their problem (p=0.001) and whether patients reported adherence to treatment guidelines (p=0.001) or followed the proposed diet (p=0.001). Finally, statistically significant association was observed between dependency on dialysis machine as reported by the patients and relations with nursing staff (p=0.001), whether patients had noticed change in body image (p=0.001), whether they faced difficulties in social (p=0.001) and family environment (p=0.030), whether they hid their problem (p=0.006), whether they needed help in daily activities (p=0.001) and whether their lifestyle had changed (p=0.001).Socio-demographic and clinical characteristics as well as hemodialysis patients' beliefs are associated with machine dependency. This study contributed in outlining factors affecting dependency on dialysis machine, thus reinforcing multidisciplinary health care teams to develop interventions in order to address hemodialysis patients' needs.