Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury

Guillaume L. Hoareau, Carl A. Beyer, Christopher Wilson, Harris Kashtan, Andrew Wishy, J. Kevin Grayson, Lauren Walker, James Ross, Ian J. Stewart

Research output: Contribution to journalArticle

Abstract

BACKGROUND Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury. METHODS Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K + ] T390 -serum [K + ] T0 . RESULTS There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K + ] was reduced by 25% (24.9%-27.8%) across the cartridges. CONCLUSION The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments. LEVEL OF EVIDENCE Translational science study, level I.

Original languageEnglish (US)
Pages (from-to)694-701
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Hyperkalemia
Potassium
Swine
Serum
Artificial Kidneys
Polymers
Hemorrhagic Shock
Leg
Norepinephrine
Equipment and Supplies
Control Groups
Extracorporeal Circulation
Crush Injuries
Dialysis Solutions
Splenectomy
Blood Group Antigens
Nephrectomy
Reperfusion
Lactic Acid
Arterial Pressure

Keywords

  • acute kidney injury
  • extracorporeal blood purification
  • Hemoperfusion
  • potassium
  • renal replacement therapy

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Hoareau, G. L., Beyer, C. A., Wilson, C., Kashtan, H., Wishy, A., Grayson, J. K., ... Stewart, I. J. (2019). Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury. Journal of Trauma and Acute Care Surgery, 86(4), 694-701. https://doi.org/10.1097/TA.0000000000002178

Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury. / Hoareau, Guillaume L.; Beyer, Carl A.; Wilson, Christopher; Kashtan, Harris; Wishy, Andrew; Grayson, J. Kevin; Walker, Lauren; Ross, James; Stewart, Ian J.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 4, 01.04.2019, p. 694-701.

Research output: Contribution to journalArticle

Hoareau, GL, Beyer, CA, Wilson, C, Kashtan, H, Wishy, A, Grayson, JK, Walker, L, Ross, J & Stewart, IJ 2019, 'Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury', Journal of Trauma and Acute Care Surgery, vol. 86, no. 4, pp. 694-701. https://doi.org/10.1097/TA.0000000000002178
Hoareau, Guillaume L. ; Beyer, Carl A. ; Wilson, Christopher ; Kashtan, Harris ; Wishy, Andrew ; Grayson, J. Kevin ; Walker, Lauren ; Ross, James ; Stewart, Ian J. / Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 4. pp. 694-701.
@article{a209fb8226904b0c9b3906d28228cb35,
title = "Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury",
abstract = "BACKGROUND Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury. METHODS Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9{\%} saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K + ] T390 -serum [K + ] T0 . RESULTS There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K + ] was reduced by 25{\%} (24.9{\%}-27.8{\%}) across the cartridges. CONCLUSION The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments. LEVEL OF EVIDENCE Translational science study, level I.",
keywords = "acute kidney injury, extracorporeal blood purification, Hemoperfusion, potassium, renal replacement therapy",
author = "Hoareau, {Guillaume L.} and Beyer, {Carl A.} and Christopher Wilson and Harris Kashtan and Andrew Wishy and Grayson, {J. Kevin} and Lauren Walker and James Ross and Stewart, {Ian J.}",
year = "2019",
month = "4",
day = "1",
doi = "10.1097/TA.0000000000002178",
language = "English (US)",
volume = "86",
pages = "694--701",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Extracorporeal potassium binding for the management of hyperkalemia in an anephric model of crush injury

AU - Hoareau, Guillaume L.

AU - Beyer, Carl A.

AU - Wilson, Christopher

AU - Kashtan, Harris

AU - Wishy, Andrew

AU - Grayson, J. Kevin

AU - Walker, Lauren

AU - Ross, James

AU - Stewart, Ian J.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BACKGROUND Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury. METHODS Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K + ] T390 -serum [K + ] T0 . RESULTS There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K + ] was reduced by 25% (24.9%-27.8%) across the cartridges. CONCLUSION The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments. LEVEL OF EVIDENCE Translational science study, level I.

AB - BACKGROUND Potassium-binding polymers have shown promising results in an anephric porcine hyperkalemia model. The benefits of the polymer in a clinically relevant injury model remain unknown. We hypothesized that potassium-binding cartridges would control serum potassium concentration in a porcine hemorrhagic shock model with supraceliac aortic occlusion and a limb crush injury. METHODS Ten Yorkshire-cross swine were anesthetized and instrumented. Pigs underwent splenectomy and bilateral nephrectomy. Hemorrhagic shock was induced for 30 minutes while a leg compression device was applied. Pigs underwent supraceliac aortic occlusion for 60 minutes and were resuscitated with shed blood. The leg compression device was removed 20 minutes after balloon deflation. After 20 minutes of reperfusion, animals were randomized to extracorporeal circulation with (treatment) or without (control) the potassium binding cartridges. In both groups, blood was circulated through a hemodialyzer with a peristaltic pump. In the treatment group, the ultrafiltrate was diverted from the hemodialyzer through cartridges containing the polymer and returned to the extracorporeal circuit. Animals were resuscitated with 0.9% saline boluses and a norepinephrine infusion. The change in serum potassium concentration (ΔK) was calculated as serum [K + ] T390 -serum [K + ] T0 . RESULTS There was a significant difference in serum potassium concentration between groups (p < 0.001). ΔK was significantly higher in the control than the treatment group (3.75 [3.27-4.42] and 1.15 [0.62-1.59] mmol/L, respectively; p = 0.03). There were no differences in mean arterial pressure (p = 0.14), isotonic crystalloids requirement (p = 0.51), or norepinephrine dose (p = 0.83) between groups. Serum lactate concentration was significantly higher in the control group (p < 0.001). At the end of the experiment, the [K + ] was reduced by 25% (24.9%-27.8%) across the cartridges. CONCLUSION The cartridges controlled serum potassium concentrations without dialysate and retained potassium binding capabilities over 4 hours. There were no deleterious effects on hemodynamic parameters. Those cartridges might be beneficial adjuncts for hyperkalemia management in austere environments. LEVEL OF EVIDENCE Translational science study, level I.

KW - acute kidney injury

KW - extracorporeal blood purification

KW - Hemoperfusion

KW - potassium

KW - renal replacement therapy

UR - http://www.scopus.com/inward/record.url?scp=85063712036&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063712036&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002178

DO - 10.1097/TA.0000000000002178

M3 - Article

VL - 86

SP - 694

EP - 701

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -