Infant Renal Replacement Therapy Using Carpediem: A Multicenter Observational Cohort Study from the ICONIIC Learning Network

Abstract

Objective: To evaluate indications and outcomes of Carpediem as the first infant-specific continuous renal replacement therapy (CRRT) platform available for clinical use in the US.

Study design: A multicenter, retrospective, and prospective observational study was conducted through the "Improving CRRT Outcomes in Neonates and Infants through Interdisciplinary Collaboration" Learning Network. Data were collected from the first four US centers utilizing Carpediem. A treatment course was defined as sequential CRRT procedures separated by ≤72 hours. Infant cohorts were categorized by CRRT indication: end-stage kidney disease (ESKD) (ie, CRRT as a bridge to peritoneal dialysis) and non-ESKD (all other indications).

Results: Sixty-seven infants underwent 93 treatment courses using 1538 filters and 112 vascular access catheters. The primary indication for CRRT was ESKD in 36 (54%) and acute kidney injury in 43%. Median age at first treatment was 18 (IQR: 6, 81) days, and dry weight was 2.6 (IQR: 2.4, 3.1) kg for the ESKD cohort and 32 (IQR: 9, 90) days and 3.4 (IQR: 3.2, 4.5) kg for the non-ESKD cohort. Median treatment course duration was 12 (IQR: 3, 24) days for ESKD compared with 4 (IQR: 1, 13) days for non-ESKD infants. Survival for hospital discharge was 67% in ESKD and 60% in non-ESKD.

Conclusions: In this US cohort study, CRRT survival in infants treated with Carpediem exceeds 60%. More than one-half of the treatment indications were for ESKD as a bridge to dialysis.

Keywords: Carpediem; ICONIIC; acute kidney injury; congenital kidney failure; continuous kidney replacement therapy; end-stage kidney disease; fluid overload; infant; neonatal; pediatric.