Fig. 2

Full Circuit used for CKRT Dialysate Production. To illustrate the equipment used in better detail, we staged an additional session of CKRT dialysate production after the pandemic (Panel 1). Components of the circuit include (A) a liquid hemodialysis acid concentrate source (Naturalyte, Fresenius), (B) a powered bicarbonate concentrate source (BiCart, Baxter), (C) an IHD machine (Gambro Phoenix, Baxter) programmed to run in standard mode with dialysate flow rate of 800 mL/min and blood pump speed of 0, and (D) a standard IHD dialyzer (Revaclear, Baxter) connected through the inlet dialysate port to the clean dialysate supply and connected (Panel 2) by the effluent port via an adaptor to (E) a sterile TPN bag (Exactamix Empty EVA Bag, Baxter). To prevent the device from alarming or automatically entering bypass mode, an unprimed cartridge blood set is applied and the dialysate waste line (i.e., red dialysate connector, asterisk in Panel 1) is disengaged (though it is loosely attached to the machine in this image). The connectors (Panel 3) used to connect the TPN bags in the implementation phase of our CKRT dialysate production system are composed of biocompatible rigid material (“Figure 4 MED-WHT 10”, 3D Systems) and – though non-sterile – are designed specifically to not come into contact with the dialysate fluid. Abbreviations: CKRT, continuous kidney replacement therapy; IHD, intermittent hemodialysis; TPN, total parenteral nutrition