New Dialysis Alternative Performed at KRMC
For the first time in the hospital’s history, a continuous renal replacement therapy (CRRT) procedure was conducted at Kalispell Regional Medical Center (KRMC). A CRRT machine is used to provide renal (kidney) support to patients who are hemodynamically unstable (have low blood pressure) in place of traditional dialysis. The procedure was conducted on August 3 by Gabor Bodonyi-Kovacs, MD, a nephrologist at Greater Flathead Renal. By the early morning hours of August 6, the patient showed signs of improvement and was taken off the machine.
The patient was involved in a car accident and sustained severe injuries that complicated her existing kidney disease. Normally, she would have had traditional dialysis treatment to filter the waste from her body, but because she was hemodynamically unstable and traditional dialysis would have lowered her blood pressure, that technique was out of the question.
Whereas traditional dialysis would generally take three or four hours to filter waste from the body, CRRT is a constant process that requires around the clock supervision from medical staff. In the process, the waste is removed in a gentler manner that better resembles the kidney’s natural function. “Your kidneys work 24 hours a day to filter waste from your body,” says Dr. Bodonyi-Kovacs. “When we use dialysis, we try to remove fluid in three or four hour windows. So when we have to remove as much fluid in a four hour window when the kidneys would normally have two days to do it, it’s very hard on the body.”
While CRRT is less strenuous on the patient, it’s much more labor intensive for staff. ICU staff monitored the patient for a combined 78 hours to ensure the procedure was carried out properly. For many of these nurses, this process was brand new, as they had just gone through the required CRRT specialty training two weeks earlier. “The ICU team was fantastic throughout this,” says Carla Genovese, director of critical care at KRMC. “They just rolled with it and stepped up to the challenge.”
For both Dr. Bodonyi-Kovacs and Genovese, this case was the payoff of nearly a year’s worth of hard work and advocacy. Back in October 2019, they attended a CRRT conference in Boston along with Sheila Robeen from DCI Dialysis to begin developing an adoption plan for KRMC. Thanks to the support of DCI, KRH Administration, and ICU staff, this was approved and training procedures were planned. Over the course of the past five months, they jumped through hurdles caused by the COVID-19 pandemic, but finally in July they made the last push to bring it to KRMC. Without this new procedure, the patient would not have had any viable options and likely would have died of kidney failure.
While this was the first CRRT at KRMC, this was not the first in Dr. Bodonyi-Kovacs’ career. He first learned how to do the procedure at Beth Israel Deaconess Medical Center at Harvard University and continued to do it wherever his career took him. Dr. Bodonyi-Kovacs’ colleagues Robert Valleau, MD, and Tobin Hoppes, MD, are also well trained to perform CRRT procedures and will continue to do so as more candidates emerge. “This hospital keeps getting busier,” continues Dr. Bodonyi-Kovacs. “As we see more referrals to the ICU, we see more patients who would benefit from this procedure. I’m thrilled that we can now offer this to our patients 24 hours a day, 365 days a year.”