{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T06:32:05Z","timestamp":1768717925167,"version":"3.49.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T00:00:00Z","timestamp":1709164800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100007001","name":"Small Business Innovative Research and Small Business Technology Transfer","doi-asserted-by":"publisher","award":["W81XWH-17-C-0142"],"award-info":[{"award-number":["W81XWH-17-C-0142"]}],"id":[{"id":"10.13039\/100007001","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007001","name":"Small Business Innovative Research and Small Business Technology Transfer","doi-asserted-by":"publisher","award":["W81XWH-17-C-0142"],"award-info":[{"award-number":["W81XWH-17-C-0142"]}],"id":[{"id":"10.13039\/100007001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>United States Military operations in resource limited areas are increasing. Furthermore, future peer or near-peer conflicts will require caring for larger numbers of casualties with limited resources. In this setting, traditional renal replacement therapy is not feasible and novel methods are required to address severe acute kidney injury in austere environments lacking definitive therapies. Here, we describe experiments designed to determine the efficacy of a novel peritoneal packing material (Potassium Binding Pack-PBP, CytoSorbents INC) for the acute management of severe hyperkalemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Male swine (52 \u00b11\u2009kg) were nephrectomized via midline laparotomy under a plane of anesthesia and randomized into one of two experimental groups (PBP &amp; CON). Exogenous potassium was infused to achieve a serum potassium level of 7.5\u2009mEq\/L. Novel potassium absorbing packs (PBP) or sham packs (CON) were placed in the right and left upper quadrants, and the right and left paracolic gutters of the abdomen to simulate four-quadrant packing (n\u2009=\u20096, n\u2009=\u20095, respectively). Two liters of peritoneal dialysis fluid was instilled into the abdomen and temporary closure performed. Animals were observed for 12 hours. Serum and peritoneal fluid (dialysate) potassium levels were sampled at T\u2009=\u200915, 30, 60\u2009min, and Q60min thereafter. Animals were humanely euthanized at the end of the observation period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Baseline characteristics were similar between groups. Pairwise analysis showed that serum potassium concentrations were significantly lower in the PBP group compared to CON at T\u2009=\u2009540 and T\u2009=\u2009720 (P\u2009=\u20090.006 and P\u2009=\u20090.015, respectively). Potassium concentrations were significantly lower in dialysate of the PBP group compared to CON at all time points after T\u2009=\u200915 (T\u2009=\u200930, P\u2009=\u20090.017; T\u2009=\u200960 through T\u2009=\u2009720, P\u2009&amp;lt;\u20090.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This is the first demonstration of an effective technology for the management of hyperkalemia in trauma in the absence of standard of care; renal replacement therapy. We identified that PBP was able to consistently maintain a concentration gradient between dialysate in the peritoneum and system potassium concentration throughout the experiment. Furthermore, systemic potassium concentrations were reduced in a clinically relevant manner in the PBP group compared to CON. This suggests that peritoneal packing technology for the management of metabolic disturbances in trauma has potential for clinical application. These results are preliminary and should be interpreted with caution.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usae018","type":"journal-article","created":{"date-parts":[[2024,2,29]],"date-time":"2024-02-29T17:10:55Z","timestamp":1709226655000},"page":"e1432-e1436","source":"Crossref","is-referenced-by-count":2,"title":["A Novel Peritoneal Packing Method for Management of Hyperkalemia During Acute Kidney Injury in Trauma"],"prefix":"10.1093","volume":"189","author":[{"given":"Eric M","family":"Zimmerman","sequence":"first","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health Science University , Portland, OR 97239,","place":["USA"]},{"name":"Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University , Portland, OR 97239,","place":["USA"]},{"name":"Department of Surgery, New York Presbyterian , Queens, NY 10065,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian J","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Medicine, Uniformed Services University , Bethesda, MD 20814,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2255-6603","authenticated-orcid":false,"given":"Todd L","family":"Graham","sequence":"additional","affiliation":[{"name":"Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University , Portland, OR 97239,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy J","family":"Kovacs","sequence":"additional","affiliation":[{"name":"Cytosorbents Medical Inc. , Princeton, NJ 08540,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamaz","family":"Guliashvili","sequence":"additional","affiliation":[{"name":"Cytosorbents Medical Inc. , Princeton, NJ 08540,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas D","family":"Golobish","sequence":"additional","affiliation":[{"name":"Cytosorbents Medical Inc. , Princeton, NJ 08540,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D","family":"Ross","sequence":"additional","affiliation":[{"name":"Charles T. Dotter Department of Interventional Radiology, Oregon Health and Science University , Portland, OR 97239,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,2,28]]},"reference":[{"issue":"3","key":"2025030420270853200_R1","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1001\/archsurg.1960.01290200010002","article-title":"The surgical volumes of the history of the United States Army Medical Department in World War II. The physiologic effects of wounds","volume":"80","author":"Beecher","year":"1960","journal-title":"Arch Surg"},{"issue":"2","key":"2025030420270853200_R2","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/0002-9343(55)90234-5","article-title":"Post-traumatic renal insufficiency in military casualties. II. Management, use of an artificial kidney, prognosis","volume":"18","author":"Smith","year":"1955","journal-title":"Am J Med"},{"issue":"4","key":"2025030420270853200_R3","doi-asserted-by":"publisher","first-page":"564","DOI":"10.1053\/j.ajkd.2016.03.419","article-title":"Acute kidney injury in critically injured combat veterans: a retrospective cohort study","volume":"68","author":"Stewart","year":"2016","journal-title":"Am J Kidney Dis"},{"issue":"5","key":"2025030420270853200_R4","doi-asserted-by":"publisher","first-page":"988","DOI":"10.1097\/TA.0000000000000607","article-title":"Early acute kidney injury in military casualties","volume":"78","author":"Heegard","year":"2015","journal-title":"J Trauma Acute Care Surg"},{"issue":"10","key":"2025030420270853200_R5","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.2215\/CJN.00890115","article-title":"Outcomes after post-traumatic AKI requiring RRT in United States Military Service 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Earthquake","volume":"70","author":"He","year":"2011","journal-title":"J Trauma"}],"container-title":["Military 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