Selective Cytopheretic Device Use in Continuous Kidney Replacement Therapy in Children: A Cohort Study With a...

Area of Science:

• Pediatric Nephrology
• Critical Care Medicine
• Biomedical Engineering

Background:

• Critically ill children with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) face high mortality risks.
• The selective cytopheretic device (SCD) offers immunomodulatory effects, with prior adult studies suggesting improved survival and dialysis independence.

Purpose of the Study:

• To evaluate the safety and feasibility of CRRT integrated with the SCD (CRRT-SCD) in critically ill children.
• To compare survival outcomes of pediatric patients treated with CRRT-SCD against a historical CRRT cohort.

Main Methods:

• Prospective, multicenter studies involving 22 critically ill children (≥10 kg) with AKI and multi-organ dysfunction receiving CRRT-SCD.
• Comparison of survival rates and renal function (estimated glomerular filtration rate, dialysis dependence) with a matched historical pediatric CRRT cohort using multivariable and Bayesian analyses.

Main Results:

• Fifteen serious adverse events were reported, none related to the SCD.
• Seventeen out of 22 patients survived to ICU discharge or day 60.
• Both analytical approaches indicated a probable benefit from adding SCD, with most survivors showing normal kidney function and no dialysis dependence at 60 days.

Conclusions:

• CRRT-SCD therapy is safe and feasible in critically ill pediatric patients with AKI.
• The addition of SCD to CRRT in children demonstrates a probable survival benefit.
• Further research with larger sample sizes is warranted to confirm these findings.