Aquapheresis: An Institutional Experience.

BACKGROUND: Aquapheresis (AQ) consists of the extracorporeal extraction of plasma water from the vascular space across a semipermeable membrane in response to a transmembrane pressure gradient. The primary utilization of AQ has been in the management of patients with diuretic resistant heart failure with a treatment goal directed to quickly eliminate the excess fluid and optimize volume status. This modality is similar to isolated ultrafiltration performed on those patients requiring dialysis, but utilizes a machine that is smaller and easier to initiate and operate compared with traditional dialysis equipment. METHOD: A retrospective study that describes the indications in which AQ was utilized at Lenox Hill Hospital. The patient list was generated by searching for the keyword "Aquaph" in our electronic health record (EHR) orders. Patients were categorized based on hospital location and indication of AQ therapy. Additional information includes duration of treatment (days), changes in creatinine (start of AQ to stop of AQ), and total volume removed. RESULTS: The search generated 28 patients; five were excluded as AQ was not initiated. In the remaining 23 patients, the mean aquapheretic volume per day was 1954 mls, with no significant change in creatinine. Indications for AQ broke out into five main categories: cardiogenic shock including post cardiothoracic procedure (10 pts); anasarca (5 pts); ATN with volume overload (4 pts); ESKD with bridge ultrafiltration between hemodialysis treatments (2 pts); and post-op volume overload (2 pts). CONCLUSION: We found that aquapheresis can be utilized in situations other than diuretic resistant heart failure. Also to consider, is the ease in which this less complicated aquapheresis equipment can be operated compared to the more complex hemodialysis equipment.

Novel Approaches to Arteriovenous Access Creation, Maturation, Suitability, and Durability for Dialysis.

Since the arteriovenous fistula (AVF) was first conceived over 50 years ago, the goal to create a vascular conduit with predictable and reproducible maturation and durability continues to elude caregivers. Recently, however, advances in the understanding of vascular biology and new technologies now provides us with some optimism; we are moving toward a viable solution. A quickly maturing, sustainable, and durable arteriovenous access may soon be attainable. This review will discuss these advances. There are novel approaches to AVF creation and devices to enhance maturation, advances in arteriovenous graft material(s), and devices to safely prolong the use of tunneled dialysis catheters. Although hemodialysis (HD) access remains a complex problem, these innovations may lead the way to optimizing the care and the quality of life of those patients who have no choice but to proceed with HD.