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Use of the Selective Cytopheretic Device with Continuous Renal Replacement Therapy in Children: A Comparison of
Natalja L Stanski1,2, JangDong Seo3, Todd Jenkins3
1University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, natalja.stanski@cchmc.org.
Insights
The selective cytopheretic device (SCD) may improve survival and reduce treatment duration for children with acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS) receiving continuous renal replacement therapy (CRRT). Further research is needed to confirm these benefits.
Area of Science:
- Pediatric Nephrology
- Extracorporeal Therapies
- Critical Care Medicine
Background:
- The selective cytopheretic device (SCD) is an extracorporeal therapy for children with acute kidney injury (AKI) and sepsis/sepsis-like conditions undergoing continuous renal replacement therapy (CRRT).
- This study compares outcomes of children treated with SCD plus CRRT to those receiving CRRT alone.
Purpose of the Study:
- To evaluate the efficacy and outcomes of adding SCD therapy to CRRT in pediatric patients with AKI and multiple organ dysfunction syndrome (MODS).
- To compare treatment duration, intensive care unit (ICU) length of stay (LOS), and survival rates between the SCD and CRRT-alone groups.
Main Methods:
- A secondary analysis compared patients treated with SCD (n=18) from prospective studies to a historical cohort receiving CRRT alone (n=178).
- Patients were ≤22 years old and ≥10 kg, receiving CRRT for AKI and/or fluid overload.
- Outcomes included CRRT duration, ICU LOS, and survival to ICU discharge or day 60.
Main Results:
- SCD patients exhibited significantly shorter CRRT duration (6 vs. 10 days, p=0.013) and ICU LOS in survivors (16 vs. 27 days, p=0.012).
- Survival to ICU discharge or day 60 was higher in the SCD cohort (94% vs. 74%, p=0.079), with a >99% probability of improved survival via Bayesian analysis.
- In septic patients, SCD demonstrated improved survival (100% vs. 69%, p=0.032), shorter CRRT duration (5 vs. 11 days, p=0.006), and reduced ICU LOS (p=0.027).
Conclusions:
- Addition of SCD therapy to CRRT in pediatric patients with AKI and MODS may offer significant clinical benefits.
- SCD therapy shows potential for improving survival and reducing treatment duration in this critical patient population.
- Larger prospective studies are warranted to definitively establish the role of SCD in pediatric critical care.
Introduction:
The selective cytopheretic device (SCD) is a cell-directed extracorporeal therapy approved for use in children with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) with sepsis/sepsis-like conditions. We compared outcomes for children treated with SCD to a contemporary cohort of children treated with CRRT alone.
Methods:
Secondary analysis and comparison of patients ≤22 years old and ≥10 kg from a multicenter registry of patients receiving CRRT for AKI and/or fluid overload (WE-ROCK; 2015-2021) to patients from two multicenter, prospective, interventional studies of children with AKI and multiple organ dysfunction (MODS) receiving SCD (SCD-PED-01/SCD-PED-02; 2016-2022).
Results:
Eighteen patients in the SCD cohort were compared to 178 in the CRRT cohort. There were no differences between cohorts at CRRT ± SCD initiation. SCD patients had shorter CRRT duration (6 [3, 11] vs. 10 [5, 18] days, p = 0.013) and shorter ICU length of stay (LOS) in survivors (16 [11, 25] vs. 27 [16, 46] days, p = 0.012). Survival to ICU discharge or day 60 was 94% in the SCD cohort vs. 74% in the CRRT cohort (p = 0.079). A Bayesian analysis demonstrated a >99% probability of improved survival with SCD. A sub-analysis in septic patients demonstrated greater survival (100% vs. 69%, p = 0.032), shorter CRRT duration (5 [3, 7] vs. 11 [6, 17] days, p = 0.006) and reduced ICU LOS in survivors (21 [10, 25] vs. 27 [16, 45] days, p = 0.027) in SCD-treated patients.
Conclusions:
The addition of SCD therapy in children with AKI and MODS receiving CRRT may be beneficial, though larger prospective studies are needed.
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