510 - In Vitro Assessment of the Kirpa Kit™ Modified Manual Single Lumen Alternating Micro-Batch Dialysis Device in Guatemala City

Publication Number: 2495.510

Laura Rangel Rodriguez, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Ana L. Galvez, Fundanier, Guatemala, Chimaltenango, Guatemala; Jolyn Morgan, Cincinnati Children's Hospital Medical Center, cincinnati, OH, United States; Amanda Snyder, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Giovanni Ceschia, University of Padova: Department of Women' and Children Health, Padova, Veneto, Italy; Denise C. Hasson, New York University Grossman School of Medicine, New York City, NY, United States; Stuart L.. Goldstein, CincinnatiChildrens, Cincinnati, OH, United States; Randall Lou-Meda, FUNDANIER, Guatemala, Santa Rosa, Guatemala

Background: Acute kidney injury (AKI) is a leading cause of morbidity and mortality in low- and middle-income countries (LMICs), where access to kidney replacement therapy (KRT) is limited by infrastructure, personnel, and cost. The Kirpa Kit™ is a manual, electricity-independent dialysis system requiring only peripheral single lumen venous access, developed to provide affordable KRT in resource-limited settings.

Objective: To evaluate in vitro solute clearance using the Kirpa Kit™ under varying dialyzer and refreshment configurations to inform protocol optimization in a pediatric LMIC nephrology center.

Design/Methods: Four in vitro experiments were conducted using 480 ml expired packed red blood cells mixed with urine (as a source of urea) and heparin. Studies #1-3 used high-flux filters and study #4 used a low-flux filter. Study #1 used continuous saline refreshment, while studies #2–4 used intermittent manual refreshment with differing volumes based on approximate dialyzer priming capacity. Each 25-minute session measured clearance of urea (BUN), potassium (K), and phosphorus (Phos); solute clearance was assessed by calculating the reduction percentage of each.

Results: Solute clearance varied by configuration (Table 1). The highest BUN and K reductions occurred with high-flux intermittent refreshment (91% and 70%, Study #2). Low-flux use (Study #4) showed comparable BUN and K reductions (76%, 77%). Continuous refreshment (Study #1) yielded lower solute reduction and resulted in passive ultrafiltration (267 ml); however, interpretation is limited by differing refreshment volumes, number of exchanges and single low-flux trial.

Conclusion(s): The Kirpa Kit™ demonstrated effective in vitro clearance of solutes across different dialyzer flux and refreshment configurations. Intermittent high-flux conditions produced the highest reductions, while low-flux performance remained comparable. These findings support its feasibility as a low-cost, electricity-independent dialysis option for AKI management in LMICs and suggest that dialyzer flux and refreshment strategy are critical variables for future protocol development.

Table 1
Kirpa Kit in vitro study - TABLE (2).pdfEach session was 25 minutes. Passive UF was only achieved in Study #1.