CRRT Solutions: Dialysate

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CRRT Solutions Dialysate Replacement Fluids

• By
• Kevin D. McBryde, MD
• Assistant Professor of Pediatrics
• Center for Heart, Lung Kidney Diseases
• Center for Clinical Research and Experimental
  Therapeutics
• Childrens National Medical Center
• Washington, DC

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Dialysate Solutions

• Solution remains outside of the patients
  blood-space.
• Dialysate separated from blood by dialyzer filter
  membrane.
• Regarded as medical device by US Food Drug
  Administration.

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Dialysate Solutions

• Normocarb (Dialysis Solutions, Inc., Richmond
  Hill, Ontario, Canada)

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Normocarb

• Produced in 240 mL glass ampule.
• Glass prevents diffusion of HCO3- from solution
  out of container.
• Added to 3 L of sterile water.
• Produces 3.24 L of dialysate solution.
• Cost 30/3.24 L

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Dialysate Solutions

• Prismasate (Gambro Renal Products, Inc.,
  Lakewood, CO)
• Reproduced by permission of Gambro Renal
  Products, Inc., Lakewood, CO.

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Prismasate

• Produced in 5 L dual-chamber, double-layered
  plastic bags.
• Dual-layer plastic prevents diffusion of HCO3-
  from solution out of container.
• To produce dialysate, break plastic plug
  separating upper and lower chambers.
• Available in multiple preparations.
• Produces 5 L of dialysate solution.
• Cost 30/5 L

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Prismasate
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Dialysate Solutions

• Duosol (B. Braun, Melsungen, Germany)
• Reproduced by permission of B. Braun, Melsungen,
  Germany.

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Duosol

• Produced in 5 L dual-chamber, double-layered
  plastic bags.
• Dual-layer plastic prevents diffusion of HCO3-
  from solution out of container.
• To produce dialysate, break plastic plug
  separating upper and lower chambers.
• Available in multiple preparations.
• Produces 5 L of dialysate solution.
• Cost ??/5 L

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Duosol
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Dialysate Solutions

• Accusol (Baxter Healthcare Inc., Deerfield, IL)
• Reproduced by permission of Baxter Healthcare,
  Inc., Deerfield, IL.

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Accusol

• Produced in 2.5 L dual-chamber, double-layered
  plastic bags.
• Dual-layer plastic prevents diffusion of HCO3-
  from solution out of container.
• To produce dialysate, break plastic plug
  separating upper and lower chambers.
• Available in multiple preparations.
• Produces 2.5 L of dialysate solution.
• Cost 10/2.5 L

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Accusol
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Replacement Fluids

• Replacement fluids added directly into the
  patients blood-space.
• May be added either pre- or post-filter.
• No currently Food Drug Administration approved
  commercial replacement fluid.
• Considered a medication by the FDA.