Kidney Week

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

• AKI Predictors and Outcomes: Research Abstracts
  October 23, 2020 | Location: Simulive
  Abstract Time: 05:00 PM - 07:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stuart Goldstein, MD, FASN



Stuart L Goldstein, MD, is the Clark D West Endowed Chair, Professor of Pediatrics and Director, Center for Acute Care Nephrology at Cincinnati Children’s Hospital Medical Center. He received his medical degree from Columbia University, completed his pediatric residency at Baylor of Medicine in Houston, Texas, and completed both clinical and research fellowships in pediatric nephrology at the Children’s Hospital in Boston, Massachusetts. Dr Goldstein is a member of the American Academy of Pediatrics, the American Society of Nephrology, the International Pediatric Nephrology Association, the American Society of Pediatric Nephrology, the International Society of Nephrology, and the Society for Pediatric Research. He is the Pediatric Nephrologist Representative for the International Society of Nephrology Commission of Acute Renal Failure, and served to the Council of the American Society of Pediatric Nephrology. Dr Goldstein has developed and validated the pediatric modified RIFLE (pRIFLE) AKI criteria, is Founder and Principal Investigator for the Prospective Pediatric AKI Research Group, which conducted the largest multinational prospective AKI study in children, AWARE, results of which have been published in the New England Journal of Medicine. He has evaluated novel urinary AKI biomarkers in the pediatric critical care setting. He was one of two pediatric work group members for the KDIGO International AKI Guideline Work Group and has served on the KDOQI Hemodialysis Adequacy, Vascular Access and Pediatric Nutrition Guideline Work Groups. He has led a multicenter national effort to reduce nephrotoxic AKI in children. He has written over 300 journal articles, served as an Editor for two pediatric nephrology related textbooks and contributed book chapters to numerous texts including, Critical Care Nephrology, Evidence-Based Nephrology, Handbook of Dialysis Therapy, Management of Acute Kidney Problems, Pediatric Critical Care, Pediatric Nephrology, and Pediatric Nephrology in the ICU.

• Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Kelli A. Krallman,

• Kirby, Cassie L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Cassie L. Kirby,

• Askenazi, David J., The University of Alabama at Birmingham, Birmingham, Alabama, United States

David J. Askenazi,

• Basu, Rajit K., Children's Healthcare of Atlanta Inc, Atlanta, Georgia, United States

Rajit K. Basu,

• Selewski, David T., Medical University of South Carolina, Charleston, South Carolina, United States

David T. Selewski,

• Humes, H. David, University of Michigan, Ann Arbor, Michigan, United States

H. David Humes,

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