The Science of Extracorporeal Ultrafiltration: Introducing a Novel Miniaturized Device

Introduction. Fluid overload has been associated with untoward outcomes in a variety of clinical settings. Isolated extracorporeal ultrafiltration (UF) allows for mechanical extraction of excess fluid and optimization of volume status without the established risks associated with use of high dose diuretics. Conventional machines for renal replacement therapy can be used to perform isolated UF. However, they typically need high blood flow rates with high circuit volumes and the therapy has to be performed by trained nurses. Herein, we describe a novel device, the Artificial Diuresis-1, or AD 1 (Medica S.p.A., Medolla, Italy), which is a portable technology designed to perform extracorporeal UF at bedside. Materials and Methods. The AD 1 uses a polysulfone mini-filter to generate ultrafiltrate with the help of two forces: blood flow (Qb) and gravity (based on the height at which the ultrafiltrate collection bag is placed). In vitro experiments were performed using human blood to evaluate vascular access pressures and ultrafiltrate volumes using various central venous catheters (12 Fr bilume, 10 Fr with 2 separate lumens, pediatric catheter 7 Fr). A variety of combinations were tested with Qb of 20, 35, 50 mL/min and collection bag height at 20, 40, 60 cm, measuring the UF rate per minute each while monitoring the pressures in the venous and arterial lines and filtration fraction. Results. The device's performance was as expected. Regarding the pediatric CVC, it was possible to perform measurements only with a Qb of 20 mL/min due to increased venous pressure. Ultrafiltration rates when lines were directly connected to the blood container as well as for CVC Tesio ranged from 3.7 to 11 mL/min, for the CVC Niagara (TM) from 4.5 to 12.5 mL/min and for the CVC 7 Fr from 8.5 to 10 mL/min. The pressures of the vascular accesses were kept within a range of -5/-40 mmHg for the artery and +10/+70 mmHg for the vein. The highest venous pressure values were found with the CVC 7 Fr (+80/+100 mmHg). Conclusions. This novel device allows to treat patients with fluid overload in a variety of settings, from low-intensity department such as long-term care facilities to the intensive care unit. The device is small and portable, has a simple design, and is user-friendly. Future studies will be needed to evaluate whether gentle ultrafiltration and treatment of volume overload will translate into improvement in clinical outcomes such as a reduction in congestion-related hospital admission.

Automated summary

AD 1 is a portable device that can be used to treat patients with fluid overload. It generates ultrafiltrate using a polysulfone mini-filter based on blood flow and gravity. Further studies are needed to evaluate whether gentle ultrafiltration and treatment of volume overload will improve clinical outcomes.