Emergency Renal Replacement Therapy with Manual Dialysis in Patients with Acute Kidney Injury: First-in-Human Case Report.

Abstract

Introduction: Untreated severe renal disease can be fatal, and renal replacement therapy (RRT) is often essential for survival. However, access to RRT can be limited by resource constraints, particularly in emergency or austere settings. There is a critical need for portable, cost-effective, and efficient medical devices capable of delivering RRT. This case report describes the first-in-human use of the "Kirpa Kit procedure," a manual dialysis device designed to provide RRT when conventional dialysis resources are unavailable or overwhelmed.

Case presentation: A 37-year-old previously healthy male presented with a gunshot wound to the left leg, resulting in significant vascular injury and hemorrhagic shock requiring surgical intervention. Postoperatively, the patient remained intubated and hemodynamically unstable, developing stage 3 acute kidney injury necessitating continuous renal replacement therapy (CRRT). Due to further deterioration and the need for amputation, the patient was confined to the operating room (OR), where CRRT could not be performed. Given the patient's anuria and fluid overload, the nephrology team assessed the patient and determined he was a suitable candidate for manual dialysis using the Kirpa Kit™, with ultrafiltration (UF) as the primary objective for fluid removal. A total of 600 mL of UF was safely removed (UF rate of 600 mL/h), and the patient demonstrated both clinical and ultrasonographic improvement. Notably, portal vein pulsatility decreased from 38% to 31% following the procedure, indicating a reduction in fluid overload. The patient's vital signs remained stable throughout.

Conclusion: The Kirpa Kit procedure was successfully and safely used to manage fluid overload in a critically ill patient, demonstrating its potential as an emergency dialysis device for bridging patients with renal emergencies to standard RRT in resource-limited environments. Further studies are needed to evaluate the device's broader applications and limitations.