Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device

Francesco Garzotto, Enrico Vidal, Zaccaria Ricci, Fabio Paglialonga, Mario Giordano, Nicola Laforgia, Licia Peruzzi, Massimo Bellettato, Luisa Murer, Claudio Ronco

Research output: Contribution to journalArticle

Abstract

Background: Providing extracorporeal renal support to neonates and infants involves a number of technical and clinical issues, possibly discouraging early utilization. This report aims to describe a multicenter experience of continuous kidney replacement therapy (CKRT) delivery to small infants using a device specifically designed for this age group. Methods: A retrospective cohort analysis of all patients treated with the Carpediem™ machine (Bellco-Medtronic, Mirandola, Italy) in 6 centers between June 2013 and December 2016. Results: Twenty-six neonates and small infants received 165 CKRT sessions in convective modality. Median age at neonatal intensive care unit admission 1 day (IQR 1–11), median body weight 2.9 kg (IQR 2.2–3.6). Median circuit duration 14 h (IQR 10–22), with delivered/prescribed time ratio of 84%. CKRT was conducted using 4 Fr (27%), 5 Fr (35%), 6.5 Fr (11%), and 7 Fr (3%) vascular access, and with umbilical and peripheral accesses (11% each) allowing overall median blood flow of 4.5 ml/kg/min (IQR 3.4–6) and median effluent flow rate 35 ml/kg/h (IQR 28–42). Circuits were primed with normal saline in 58% of treatments, colloids in 31%, and packed red blood cells in 11%. No serious adverse events directly related to machine application were reported by any center. Twenty-five (96%) patients survived their CKRT course and 13 patients (50%) survived to ICU discharge. Conclusions: CKRT in neonates was easy to initiate and conduct when performed with small central vascular accesses coupled with this device. A dedicated technology for infant CKRT delivery enables patients to be safely treated avoiding technical complications. [Figure not available: see fulltext.]

Original languageEnglish
JournalPediatric Nephrology
DOIs
Publication statusAccepted/In press - Jan 1 2020

Keywords

  • Acute kidney injury
  • Continuous renal replacement therapy
  • Dialysis
  • Infants
  • Neonates

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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