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Related Experiment Video

Updated: Jan 20, 2026

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Kidney Support in Children using an Ultrafiltration Device: A Multicenter, Retrospective Study.

Shina Menon1, John Broderick2,3, Raj Munshi1

  • 1Division of Pediatric Nephrology, Seattle Children's Hospital, University of Washington, Seattle, Washington.

Clinical Journal of the American Society of Nephrology : CJASN
|August 30, 2019
PubMed
Summary

This study shows that an ultrafiltration device can be used for kidney replacement therapy (KRT) in critically ill children, with fewer complications in neonates. Size-appropriate machines are needed for better pediatric KRT.

Keywords:
acute kidney injuryacute renal failureadultchildchronic kidney failurecritical illnessdemographydialysisdiureticsgrasslandheart failurehemofiltrationhumansinfantinfant, newbornkidney dialysiskidney failure, chronickidney replacement therapyrenal dialysisrenal replacement therapyretrospective studiesultrafiltration

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Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Medical Device Technology

Background:

  • Kidney replacement therapy (KRT) in critically ill neonates and small children presents significant technical challenges due to the use of adult-sized equipment.
  • Existing KRT methods for small patients often require large catheters and significant extracorporeal volume, increasing complication risks.
  • The Aquadex FlexFlow System, an ultrafiltration device with a low extracorporeal volume, offers a potential solution for fluid management in pediatric patients.

Purpose of the Study:

  • To evaluate the feasibility and outcomes of using an ultrafiltration device for various KRT modalities in a pediatric population.
  • To assess circuit characteristics, complications, and survival rates in neonates and children undergoing KRT with this device.
  • To identify the unmet need for pediatric-specific KRT devices.

Main Methods:

  • A multicenter, retrospective case series involving 119 pediatric admissions and 884 circuits using an ultrafiltration device for KRT.
  • Patients were stratified by weight (<10 kg, 10-20 kg, >20 kg) and received slow continuous ultrafiltration, continuous venovenous hemofiltration (CVVH), or prolonged intermittent KRT.
  • Primary outcome measured was survival to the end of KRT, with secondary analysis of demographics, circuit characteristics, and complications.

Main Results:

  • Treatment indications varied by weight group, with acute kidney injury (AKI) and volume overload being common in smaller children (<10 kg).
  • Patients <10 kg had lower KRT survival rates (60%) compared to those >20 kg (97%) and experienced more volume overload at onset.
  • Complications during therapy occurred in 15% of treatments, predominantly related to vascular access; cardiovascular complications at initiation were rare (3%) and not severe.

Conclusions:

  • This study represents the first pediatric experience with an ultrafiltration device for diverse KRT therapies, including CVVH and prolonged intermittent KRT.
  • Initiation of KRT using this device was associated with minimal complications, particularly in critically ill neonates.
  • There is a clear need for KRT devices specifically designed for pediatric patients to improve care for smaller children requiring kidney support.