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Survival of infants treated with CKRT: comparing adapted adult platforms with the Carpediem™
Stuart L Goldstein1, Enrico Vidal2, Zaccaria Ricci3
1Cincinnati Children's Hospital, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA. tuart.goldstein@cchmc.org.
Insights
The Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) shows improved survival rates for infants with acute kidney injury (AKI) requiring continuous kidney replacement therapy (CKRT). This specialized device offers better outcomes for critically ill neonates and small children.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Medical Device Technology
Background:
- Neonates and infants with acute kidney injury (AKI) requiring kidney replacement therapy (KRT) historically faced poor outcomes using adapted adult devices or peritoneal dialysis.
- Continuous kidney replacement therapy (CKRT) in children under 10 kg using adult devices showed lower survival rates (44%) compared to those over 10 kg (64%).
- A dedicated CKRT device for small infants could significantly improve treatment outcomes.
Purpose of the Study:
- To compare the outcomes and patient severity of illness between the CARPEDIEM registry and the Prospective Pediatric CRRT (ppCRRT) registry.
- To evaluate the effectiveness of the CARPEDIEM device in providing CKRT for newborns and small infants.
Main Methods:
- A retrospective cohort analysis was conducted across 6 Italian pediatric intensive care units.
- Patient data from the CARPEDIEM and ppCRRT registries were compared, focusing on cohorts < 10 kg and a weight-matched cohort < 5 kg.
- Outcomes, including survival to CKRT termination and need for vasoactive medication, were analyzed.
Main Results:
- CARPEDIEM subjects exhibited higher survival rates to CKRT termination (33/34) compared to ppCRRT subjects (21/48).
- Patients in the CARPEDIEM registry required less vasoactive medication at CKRT initiation.
- Multivariable logistic regression identified the CARPEDIEM registry cohort as significantly associated with survival to CKRT discontinuation.
Conclusions:
- The CARPEDIEM device is associated with excellent survival rates in pediatric patients receiving CKRT.
- Findings suggest that specialized devices like CARPEDIEM can improve outcomes for critically ill neonates and infants with AKI.
- Results should be interpreted cautiously due to the retrospective nature and historical differences between the two registries.
Background:
The most severely ill neonates and infants with AKI who need kidney replacement therapy have had to rely upon peritoneal dialysis, or adaptations of veno-venous continuous kidney replacement therapy (CKRT) devices for adults. Data from the Prospective Pediatric CRRT (ppCRRT) registry observed children < 10 kg had a lower survival rate than children > 10 kg (44% vs. 64%, p < 0.001). A CKRT device designed specifically for small children could improve outcomes. The Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM™) is specifically dedicated to providing CKRT for newborns and small infants.
Methods:
We performed a retrospective cohort analysis comparing patient severity of illness and outcomes between the ppCRRT and CARPEDIEM registries, involving 6 Italian pediatric intensive care units. Thirty-eight subjects from the CARPEDIEM registry and 84 subjects from the ppCRRT registry < 10 kg were screened for comparison. We compared patient outcomes with a weight-matched cohort (< 5 kg) of 34 patients from the CARPEDIEM registry and 48 patients from the ppCRRT registry.
Results:
The ppCRRT subjects had higher rates of vasoactive medication at CKRT initiation. Survival to CKRT termination was higher for CARPEDIEM subjects (33/34 vs. 21/48, p < 0.0001). Multivariable logistic regression showed that CARPEDIEM registry cohort was the only variable to retain an association with survival to CKRT discontinuation.
Conclusions:
We suggest children receiving CKRT using CARPEDIEM have excellent survival. Our data should be interpreted with caution given the retrospective comparison across two eras more than a decade apart.
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