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Kidney Week

Abstract: SA-PO602

Clearance and Nutrition in Neonatal Continuous Kidney Support Therapy (CKST) Using the CARPEDIEM System

Session Information

  • Pediatric Nephrology - II
    November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Vuong, Kimmy Thien, Baylor College of Medicine, Houston, Texas, United States
  • Vega, Molly Rw, Baylor College of Medicine, Houston, Texas, United States
  • Heise, Pamela, Baylor College of Medicine, Houston, Texas, United States
  • Swartz, Sarah J., Baylor College of Medicine, Houston, Texas, United States
  • Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
  • Osborne, Scott W., Baylor College of Medicine, Houston, Texas, United States
  • Rhee, Christopher J., Baylor College of Medicine, Houston, Texas, United States
  • Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
  • Joseph, Catherine, Baylor College of Medicine, Houston, Texas, United States
Background

Improved solute clearance has been associated with improved dietary protein intake estimated by normalized protein catabolic rate (nPCR) and better nutritional status in pediatric CKST. Optimizing nutrition in neonatal CKST to ensure adequate growth can be challenging and requires appropriate clearance. The Cardio-Renal, Pediatric Dialysis Emergency Machine (CARPEDIEM™, Bellco-Medtronic, Mirandola, Italy) was designed as infant CKST with continuous veno-venous hemodialysis (CVVHD). Used in Italy since June 2013 and approved in the United States in April 2020 for infant CKST, we aimed to assess the solute clearance effect on nPCR receiving CKST with CARPEDIEM™ system.

Methods

Single center retrospective cohort of 8 patients who received CKST between June to December 2021. Institutional quality improvement dashboard for CKST collected real-world data for circuit characteristics prospectively. Per institutional protocol, filter performance is monitored daily with effluent urea nitrogen. Urea clearance (ml/min) was determined by the effluent rate. nPCR was calculated using the Edefonti equation for the first 5 and last 5 treatments for each patient, with goal nPCR value > 1 g urea nitrogen/kg/day.

Results

8 infants received a total of 272 CKST sessions (162 using 015 filter and 110 using 025 filter) for 31.8 days (IQR 21.9 – 49.6) days CKST. At CKST start, estimated dry weight was 2.61 kg (IQR 2.52 - 3.4) and actual patient weight was 3.27 kg (IQR 3.04 – 4.60). Average filter life was 18.04h, average blood flow rate was 28.36ml/min, average effluent flow rate was 50.57ml/kg/h, and median total effluent volume per day was 6509 mL (IQR 5573-7307) per patient. Urea clearance was 34.3 (IQR 23.1-59.9). Overall median nPCR was 1.20 (IQR 0.95-1.44), with lower median nPCR during the first 5 treatments (median nPCR 1.13 with IQR 0.81-1.35) compared to the last 5 treatments (median nPCR 1.22 with IQR 1.00-1.48).

Conclusion

Adequate solute clearance can be achieved using the CARPEDIEM™ system which can allow for optimization of nutritional status and promote growth among critically ill neonates.