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Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system
Kim T Vuong1, Molly R Vega2, Lauren Casey2
1Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. ktvuong@texaschildrens.org.
Insights
Infants with kidney failure receiving continuous kidney replacement therapy (CKRT) showed improved nutrition delivery but delayed growth. The Carpediem™ device facilitated safe transition to peritoneal dialysis, highlighting a need for optimized growth strategies during neonatal dialysis.
Area of Science:
- Pediatric Nephrology
- Neonatal Critical Care
- Renal Replacement Therapy
Background:
- Infants with kidney failure (KF) experience growth impairment due to fluid and protein restrictions.
- Optimizing nutrition delivery during continuous kidney replacement therapy (CKRT) is challenging in critically ill infants.
- The Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™) offers a potential solution for neonatal CKRT.
Purpose of the Study:
- To analyze delivered nutrition and growth in infants with KF undergoing CKRT using the Carpediem™ device.
- To assess the safety and efficacy of Carpediem™ as a bridge to peritoneal dialysis (PD).
Main Methods:
- Single-center observational study of infants on Carpediem™ CKRT.
- Collected data on circuit characteristics, nutrition delivery, anthropometrics, and illness severity.
- Calculated normalized protein nitrogen appearance (nPNA) as a surrogate for protein catabolism.
Main Results:
- Eight infants received CKRT for a median of 31.9 days, primarily with regional citrate anticoagulation.
- Nutritional intake (volume, protein, calories) and nPNA increased during CKRT.
- Weight gain was observed after 14 days, but goal weight and growth velocity were delayed up to 6 months post-CKRT.
Conclusions:
- Carpediem™ is a safe and effective bridge to PD for neonatal KF.
- Infants on CKRT experience delayed growth velocity despite adequate nutritional support.
- Further research is needed to optimize growth strategies in neonatal dialysis.
Background:
Infants with kidney failure (KF) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous kidney replacement therapy (CKRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CKRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™).
Methods:
Single-center observational study of infants receiving CKRT with the Carpediem™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, receiver operating characteristic curves, and Kruskal-Wallis analysis were performed using SAS version 9.4.
Results:
Eight infants received 31.9 (22.0, 49.7) days of CKRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, total calories, enteral calories, nPNA, and nitrogen balance increased on CKRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, exploratory sensitivity analysis suggests weight gain occurred after 14 days of CKRT. Despite adequate nutritional delivery, goal weight (z-score = 0) and growth velocity were not achieved until 6 months after CKRT start. Most (5 infants, 62.5%) survived and transitioned to peritoneal dialysis (PD).
Conclusions:
Carpediem™ is a safe and efficacious bridge to PD in neonatal KF. Growth velocity of infants on CKRT appears delayed despite delivery of adequate calories and protein.
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