{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,5]],"date-time":"2025-06-05T04:12:33Z","timestamp":1749096753145,"version":"3.41.0"},"reference-count":16,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,6,4]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Acute kidney injury (AKI) remains a common cause of preventable death in low-resource settings because of cost and lack of dialysis access. AKI occurs in 24\u201359% of children with severe malaria, and when severe malaria-associated acute kidney injury (SM-AKI) is complicated by hyperkalemia, mortality approaches 40%. Treatment of these children with severe anemia becomes challenging as packed red blood cells (pRBCs) have high potassium (K<jats:sup>+<\/jats:sup>) loads. We describe a protocol using the novel manual single-lumen alternating microbatch (mSLAMB) dialysis system to deplete pRBCs of K<jats:sup>+<\/jats:sup>, hypothesizing that this system can decrease K<jats:sup>+<\/jats:sup> &gt;80% in 20 minutes. Herein, we ran pRBC aliquots through the mSLAMB system using diffusive clearance. Three cycles were completed in each of four experiments. K<jats:sup>+<\/jats:sup> was measured at baseline and after every cycle to calculate K<jats:sup>+<\/jats:sup> reduction. Active ultrafiltration was performed to control net volumes, assessed as percentage of blood volume reduction and hematocrit rise. We reduced K<jats:sup>+<\/jats:sup> in pRBC aliquots by a median of 93.2% (interquartile range [IQR], 89.9\u201395.1) in a median of 20.5 minutes (IQR, 17.8\u201323.1) per experiment. Greatest median K<jats:sup>+<\/jats:sup> reduction occurred in cycle 1 (80.9%; IQR, 80.8\u201380.9), with minimal additional clearance achieved by cycle 3. Median hematocrit rise at experiment conclusion was 2.5% (IQR, 1.8\u20133.3). We conclude that mSLAMB dialysis consistently and effectively removed &gt;80% of K<jats:sup>+<\/jats:sup> from pRBCs in just over 20 minutes and facilitated volume control. Further studies are assessing transfusion risks in children with SM-AKI and hyperkalemia as this technique may allow for safer resuscitation.<\/jats:p>","DOI":"10.4269\/ajtmh.24-0756","type":"journal-article","created":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T19:10:25Z","timestamp":1744139425000},"page":"1215-1219","source":"Crossref","is-referenced-by-count":0,"title":["Manual Single-Lumen Alternating Microbatch Dialysis to Deplete Stored Blood Potassium: A Potential Use for Children with Severe Malaria-Associated Acute Kidney Injury"],"prefix":"10.4269","volume":"112","author":[{"given":"Rebecca","family":"Coriolan","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Hassenfeld Children\u2019s Hospital at New York University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apaara","family":"Chawla","sequence":"additional","affiliation":[{"name":"George Washington University, Washington, District of Columbia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jolyn","family":"Morgan","sequence":"additional","affiliation":[{"name":"Center for Acute Care Nephrology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Snyder","sequence":"additional","affiliation":[{"name":"Center for Acute Care Nephrology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Rose","sequence":"additional","affiliation":[{"name":"Center for Acute Care Nephrology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Ceschia","sequence":"additional","affiliation":[{"name":"Department for Women\u2019s and Children\u2019s Health, University Hospital of Padua, Padua, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianna","family":"Zangri","sequence":"additional","affiliation":[{"name":"Dialysis Without Borders, San Diego, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea L.","family":"Conroy","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Batte","sequence":"additional","affiliation":[{"name":"Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stuart L.","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Center for Acute Care Nephrology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise C.","family":"Hasson","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hassenfeld Children\u2019s Hospital at New York University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"year":"2024","key":"b1","article-title":"World Malaria Report 2024: Addressing Inequity in the Global Malaria Response."},{"key":"b2","series-title":"Int J Nephrol Renovasc Dis","first-page":"235","article-title":"Malaria-associated acute kidney injury in African children: Prevalence, pathophysiology, impact, and management challenges","volume":"14","author":"Batte","year":"2021"},{"key":"b3","series-title":"Clin Infect Dis","first-page":"1511","article-title":"Acute kidney injury interacts with coma, acidosis, and impaired perfusion to significantly increase risk of death in children with severe malaria","volume":"75","author":"Namazzi","year":"2022"},{"key":"b4","series-title":"Lancet Glob Health","first-page":"e242","article-title":"Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: A systematic review","volume":"4","author":"Olowu","year":"2016"},{"key":"b5","series-title":"Open Forum Infect Dis","first-page":"ofw046","article-title":"Acute kidney injury is common in pediatric severe malaria and is associated with increased mortality","volume":"3","author":"Conroy","year":"2016"},{"key":"b6","series-title":"Transfus Med Rev","first-page":"184","article-title":"Transfusion-associated hyperkalemia","volume":"25","author":"Vraets","year":"2011"},{"key":"b7","series-title":"Transfusion","first-page":"444","article-title":"High potassium levels in stored irradiated blood","volume":"27","author":"Ramirez","year":"1987"},{"key":"b8","series-title":"Pan Afr Med J","first-page":"236","article-title":"Changes in potassium and sodium concentrations in stored blood","volume":"20","author":"Opoku-Okrah","year":"2015"},{"key":"b9","series-title":"Blood Purif","first-page":"332","article-title":"Manual single-lumen alternating micro-batch device as renal replacement therapy in austere environments","volume":"52","author":"Chawla","year":"2023"},{"key":"b10","series-title":"Pediatr Res","first-page":"1335","article-title":"Manual single lumen alternating micro-batch dialysis achieves reliable clearance via diffusion","volume":"94","author":"Ceschia","year":"2023"},{"key":"b11","series-title":"QJM","first-page":"427","article-title":"Severe P. falciparum malaria in Kenyan children: Evidence for hypovolaemia","volume":"96","author":"Maitland","year":"2003"},{"key":"b12","series-title":"Vox Sang","first-page":"606","article-title":"Washed red cells: Theory and practice","volume":"115","author":"Cardigan","year":"2020"},{"key":"b13","series-title":"Transfusion","first-page":"1926","article-title":"Reduction in potassium concentration of stored red blood cell units using a resin filter","volume":"50","author":"Yamada","year":"2010"},{"key":"b14","series-title":"Lancet","first-page":"1223","article-title":"Potassium ion depletion filter for blood transfusion","volume":"343","author":"Inaba","year":"1994"},{"key":"b15","series-title":"Transfusion","first-page":"1966","article-title":"Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter","volume":"48","author":"Cid","year":"2008"},{"key":"b16","series-title":"N Engl J Med","first-page":"2483","article-title":"Mortality after fluid bolus in African children with severe infection","volume":"364","author":"Maitland","year":"2011"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1215.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1215.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/112\/6\/article-p1215.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T13:04:31Z","timestamp":1749042271000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/112\/6\/article-p1215.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":16,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.24-0756","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,6,4]]}}}