Insourced 24-Hour Prolonged Intermittent Kidney Replacement Therapy (PIKRT) in Critically Ill Patients: Multisite Outcomes from 10,000 Treatments

Background: PIKRT, introduced by Kumar in 2000, reduces nursing burden and cost while demonstrating reproducible effectiveness and safety. Davenport noted that PIKRT may reduce osmolar risks, provide greater hemodynamic stability, and operational advantages over other ICU modalities. The Tablo Hemodialysis System's (Tablo) integrated water purification and checklist-guided UI has simplified traditional PIKRT delivery and expanded the modality up to 24hrs. Methods: Transmitted data from Tablo’s cloud-based platform for acute treatments prescribed >23hrs were analyzed for cartridge usage, prescribed and achieved time and ultrafiltration (UF), alarms, and alarm resolution time. Treatments were classified as achieving treatment time within 5mins or >5mins of prescribed time. The latter were classified by sensor data as device- or user-directed (with or without an alarm), consistent with FDA benefit-risk guidance and ISO 14971 standards. Critical alarms were defined as those leading to blood pump stoppage. Alarm resolution time was obtained from device sensor data. Results: A total of 10,000 consecutive PIKRT treatments prescribed for >23hrs were analyzed across 148 hospitals. Analysis revealed 8,852 (88.5%) were completed within 5mins of prescribed time and 1,102 (11.0%) terminated >5mins by the user (Fig. 1). Prescribed time averaged 23.6±2.2hrs, and actual delivered time averaged 23.8±1.4hrs. Average UF achieved versus prescribed was 99.1% (4.0±2.6L vs 4.0±2.6L). Circuit interruptions were infrequent with 82% experiencing one or fewer cartridge changes (58% with no change). Alarm data showed 62% had one or fewer critical alarms with an average resolution time of 14.3±42.8secs (Table1). Conclusion: PIKRT treatments delivered >23hrs with Tablo were associated with high achievement of prescription goals with minimal workflow interruption. These findings support broader adoption of PIKRT with Tablo up to 24 hours for critically ill patients. Funding: Commercial Support - Outset MedicalTable 1 - Treatments (N) Average Achieved Treatment Time (hrs) Average Prescribed Treatment Time (hrs) Percent Time Achieved vs Prescribed Average Achieved Ultrafiltration (Liters) Average Prescribed Ultrafiltration (Liters) Percent Ultrafiltration Achieved vs Prescribed Average Alarm Resolution time (secs) 10,000 23.8±1.4 23.6 ±2.2 100% 3.99 ±2.6 4.03 ±2.6 99.1% 14.3 ±42.8