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. 2022 Mar;37(3):667-675.
doi: 10.1007/s00467-021-05180-y. Epub 2021 Aug 20.

Survival of infants treated with CKRT: comparing adapted adult platforms with the Carpediem™

Stuart L Goldstein  1 , Enrico Vidal  2 , Zaccaria Ricci  3 , Fabio Paglialonga  4 , Licia Peruzzi  5 , Mario Giordano  6 , Nicola Laforgia  6 , Claudio Ronco  7
Affiliations

Survival of infants treated with CKRT: comparing adapted adult platforms with the Carpediem™

Stuart L Goldstein et al. Pediatr Nephrol. 2022 Mar.

Erratum in

Abstract

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.

Keywords: Acute kidney injury; Continuous kidney replacement therapy; Infant dialysis; Neonates.

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Conflict of interest statement

Dr. Goldstein serves as a paid consultant to Bellco-Medtronic to support the CARPEDIEM application to the FDA for a marketing approval in the USA. Dr. Goldstein performed all statistical analyses for that application and the current manuscript and did not receive fees for the development of this manuscript. Bellco-Medtronic had no influence on the data analyses performed, nor did Bello-Medtronic have access to the raw data at any time during the FDA application process or the development of this manuscript.

Figures

Fig. 1
Fig. 1
Patient selection flow diagram for the six Italian center CARPEDIEM registry cohort
Fig. 2
Fig. 2
Patient selection flow diagram for the Prospective Pediatric Continuous Renal Replacement Therapy (ppCRRT) registry cohort
Fig. 3
Fig. 3
The distribution of primary disease categories leading to the need for CKRT did not differ between the CARPEDIEM and ppCRRT registry cohorts
See this image and copyright information in PMC

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