Womack’s Groundbreaking Project Will Impact Field Dialysis

Story by Dan Grubb

Womack Army Medical Center

FORT BRAGG, NC – The Department of Medicine Nephrology Service at Womack Army Medical Center are pushing the limits of what can be done to treat dialysis patients in a field environment. This unprecedented project could save the lives of soldiers during combat or civilians stricken by natural disasters who are suffering from renal failure.

Hemodialysis is a treatment for kidney failure. Normally, the kidneys work to filter blood and remove waste and excess salt and water. Kidney failure results when the kidneys can no longer filter blood or manage volume properly. With hemodialysis, a machine replaces kidney function with clever use of diffusion and convection to correct abnormalities in blood chemistry or volume overload. Blood is pumped from the body, filtered through machine, then returned to the body.

“Dialysis in and of itself has been around since the fifties, so that is nothing new,” said Master Sgt. Bartholomew Anderson, Senior Enlisted Advisor to the Deputy Commander of Medical Services at Womack Army Medical Center. “What we’re doing today is taking the first step toward proving that this machine can take the water that we can provide from our portable water tank and run a dialysis treatment in an outdoor environment.”

The machine that is currently used at Womack is fully certified by the FDA to provide a full spectrum of renal replacement therapy, including home hemodialysis. The field component, bringing it outdoors and proving that it can be done outside of a hospital with a portable water source, may result in changes in Army doctrine.

“This is the first time I’ve been involved with an experiment like this,” added Satch Saunders, a strategic professional for the company that provides Womack its dialysis machines. “We want to develop a solution for those injured in an austere environment. If their kidneys are not functioning the way they need to, how do we provide that type of care for them in the field?”

The concept is to take a dialysis machine connected to what is referred to as a “water buffalo” by military personnel (a large water tank on wheels) for use as feed water to make dialysate, the solution used to remove waste from the body by the machine. While the project faces a process of more advanced testing along the way, the work has already begun. Should a large-scale conflict with intermittent logistical support and delayed evacuation occur, risk for acute kidney injury and dialysis need will only increase. However, the successful results of the project will prove to be extremely beneficial for civilians as well.

“Think about the hurricane victims in North Carolina, for example,” said Dr. Robert Gaeta, Chief of Nephrology at Womack Army Medical Center. “They didn’t have access to fresh water, they didn’t have access to electricity, yet people still needed to get their dialysis somehow. If we can use a portable water source to run a dialysis treatment normally in a combat or disaster situation, that would be ideal. This could be a test of whether we could bring in water from another location and make into dialysate and we could run treatments for those patients.”

“Hyperkalemia has been identified as a leading cause of death during the Ukraine fight,” added Dr. David De Blasio, Medical Director for the Medical Service Line at Womack. Hyperkalemia is a condition characterized by elevated levels of potassium ions in the blood and can nausea, vomiting, fatigue, muscle weakness, confusion, and seizures. If left untreated, hyperkalemia can lead to serious complications, such as metabolic acidosis, kidney damage, cardiac arrhythmias, and death.

“Historically, the Army had a platform known as NxStage which we could use to try to treat patients for dialysis in a forward deployed environment, but that capability is really fallen to the wayside and it’s very difficult to deploy to the front lines,” added DeBlasio. “With the platform that we’re using here, this is much easier to transport but we wanted to test to see if we could treat a patient using this method. We would like to demonstrate a proof of concept that we can treat approximately ten patients from the water buffalo in a field environment.”