Successful CAVH in an austere environment using readily available disposable hospital supplies

Care of the trauma victim with acute renal failure in resource-limited locations presents a number of challenges [1]. Lack of standard haemodialysis equipment, supplies and trained personnel; unreliable and/or unsafe water sources; and non-functional or unreliable electrical systems, are some of the factors that limit the ability to care for victims with renal failure requiring renal replacement therapy. Man-made or natural disasters, such as the 1999 Marmara earthquake in Turkey, may threaten to overwhelm existing local dialytic resources, if they remain functional at all [2]. The challenge is not limited to disasters in which patients develop de novo renal failure; the chronic dialysis population itself may require the immediate implementation of alternative renal replacement therapies if patients are unable to access haemodialysis centres or hospitals, as observed during the flooding of New Orleans in the aftermath of Hurricane Katrina in 2005 [3]. We present the case of a patient with myoglobinuric acute renal failure, who was successfully managed with continuous arteriovenous haemofiltration (CAVH) in a forward-deployed military hospital, using a circuit comprised of standard haemodialysis and peritoneal dialysis equipment, and other readily available hospital supplies. Although we cannot recommend this system for large-scale implementation without further testing, given its simplicity, low cost and ready availability, the circuit herein described may be useful for disaster management teams planning for the care of multiple renal patients in austere locations if standard systems fail or become dysfunctional.