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Abstract: FR-OR04

Outcomes from the Use of the Selective Cytopheretic Device (SCD) in Critically Ill Children Receiving CRRT: A Report of the Multicenter Pediatric SCD (pSCD) Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Kirby, Cassie L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Askenazi, David J., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Basu, Rajit K., Children's Healthcare of Atlanta Inc, Atlanta, Georgia, United States
  • Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States
  • Humes, H. David, University of Michigan, Ann Arbor, Michigan, United States
Background

Critically ill children who develop acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) are at increased risk of death. The SCD promotes an immunomodulatory effect in a hypocalcemic environment (ionized Ca (ionCa) < 0.4 mmol/L) in animal models of inflammation. In a randomized trial, adult ICU patients on CRRT treated with the SCD, who maintained CRRT ionCa < 0.4 mmol/L, had improved survival/dialysis independence. We conducted an FDA grant sponsored safety evaluation (adverse and serious adverse events) of the SCD in 16 critically ill children.

Methods

4 center US study of the SCD in children (>15 kg, ≤22 years) with AKI and multiorgan failure receiving CRRT. The SCD was integrated post CRRT membrane, changed daily, and circuit ionCa maintained <0.4 mmol/L. Pts received SCD treatment for up to 7 days or CRRT discontinuation.

Results

16 pts (8F/8M) completed the study from 12/2016 thru 2/2020. Mean pt age was 12 yr (range 4-21 yr), weight was 53 kg (range 19-111 kg) and PRISM 2 score was 7 (range 2-19). Two pts received ECMO. The most common ICU diagnosis was shock. Circuit ionCa were maintained at <0.4 mmol/L for 90.2% of assessments. Median SCD duration was 6 days (range 1 to 7). 15/16 pts survived SCD therapy, 12/16 patients survived to ICU discharge. All 12 ICU survivors were dialysis independent at 60 days. No SCD related adverse events were noted.

Conclusion

Our data suggest the SCD is safe in critically ill children who require CRRT. While we cannot make efficacy claims, the 75% survival rate and 100% renal recovery rate in surviving children suggest a favorable benefit to risk ratio.

Funding

  • Other U.S. Government Support