Abstract: FR-PO089
Multicenter Evaluation of the Selective Cytopheretic Device (SCD) in Critically Ill Children Requiring CRRT: Report from the First 4 Patients
Session Information
- AKI Clinical: Predictors
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Acute Kidney Injury
- 003 AKI: Clinical and Translational
Authors
- Goldstein, Stuart, Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Selewski, David T., Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Askenazi, David J., Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Brophy, Patrick D., Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Mottes, Theresa A., Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Terrell, Tara C., Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Paden, Matthew Lee, Prospective Pediatric AKI Research Group, Cincinnati, Ohio, United States
- Humes, H. David, University of Michigan Medical School, Ann Arbor, Michigan, United States
Background
Critically ill children and adults who develop AKI requiring CRRT are at increased risk of death. In a randomized trial, adult pts on CRRT treated with the SCD, who maintained CRRT-SCD circuit ionized Ca (iCa) <0.4 mmol/L, had improved survival/dialysis independence. An CRRT-SCD circuit iCa< 0.4 mmol/L promotes an immunomodulatory effect in animal models of inflammation. We are conducting an FDA grant sponsored safety evaluation of the SCD in 16 critically ill children and report our experience with the first 4 treated patients.
Methods
5 center US study of the SCD in children (>20 kg, ≤22 years) with AKI and multi-organ failure receiving CRRT as part of standard of care. The SCD is integrated into the CRRT circuit post CRRT membrane (Figure), changed daily, and CRRT-SCD circuit iCa is maintained <0.4 mmol/L. Pts receive SCD treatment for up to 7 days or CRRT discontinuation, whichever comes first.
Results
4 pts (2F/2M) were enrolled since 12/2016 and completed SCD therapy. Age range = 12.5-17.5 years, PRISM-2 Score range = 2-14. Admission diagnoses were severe rhabdomyolysis(1), septic shock(1) STEC HUS(1) and pneumonia(1). Pts received 3 (1), 4 (1) and 7 (2) days of SCD therapy. Circuit iCa has been maintained at <0.4 mmol/L in 95% of assessments. All pts survived and were off RRT at hospital discharge. No SCD-related serious adverse events occurred. Evidence of hemolysis (increased LDH, thrombocytopenia) reversed within 24 hours of SCD therapy in the 2 pts with hemolysis at SCD initiation.
Conclusion
Our initial data suggest the SCD is safe in children. While we cannot make any efficacy claims, the unepxected early reversal of hemolysis in 2 pts may suggest a role for the SCD in mitigating leukocyte related endothelial damage.
Schematic of SCD filter intergration in the a CRRT Circuit
Funding
- Other NIH Support