Abstract: TH-PO980
Understanding Use of a Dedicated Infant Continuous Kidney Replacement Therapy Device in the United States through ICONIC: Improving Carpediem™ Outcomes in Neonates and Infants Through Collaboration
Session Information
- Late-Breaking Clinical Trials (Posters)
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Vuong, Kimmy Thien, Texas Children's Hospital, Houston, Texas, United States
- Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Casey, Lauren W, Texas Children's Hospital, Houston, Texas, United States
- Joseph, Catherine, Texas Children's Hospital, Houston, Texas, United States
- Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Morgan, Jolyn, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background
Carpediem™ (Medtronic, US) is a dedicated platform designed to provide continuous kidney replacement therapy (CKRT) in infants using heparin for anticoagulation. Infants receiving CKRT historically experienced worse outcomes attributed to the lack of CKRT devices designed for children <10 kg. We created a multicenter research collaborative aimed at improving infant outcomes.
Methods
The ICONIC study (NCT05161078) assesses infants receiving Carpediem™ (CD) prospectively, unless discharged prior to IRB approval. Aims include: describing CD prescription, delivery and establishing a registry for benchmarking efforts. A treatment course (TC) was deemed complete if >72 hrs elapsed between CD procedures. Survival to TC end was considered survival to 72 hrs post CD. Variables are described by median [IQR] or fractions (%).
Results
22 subjects were enrolled 8/2020 – 8/2022, comprising 31 TC and 499 procedures. Admit weight (wt) was 3.2 kg [2.6, 4.5]; wt at TC start 4.8 kg [3.4, 5.6]. Birth gestational age (GA) was 36 wk [33, 37] with corrected GA 43 wk [36, 47] at TC start. Most common vascular access attributes were: non-tunneled (49%), internal jugular (80%), 7.5 Fr (36%). Common TC indications were: congenital anomaly of the kidney and urinary tract with end stage kidney disease (CAKUT/ESKD) (48%) and acute kidney injury (AKI) (35%). Regional citrate anticoagulation was used most often (76%). 65% of circuits were blood primed. Continuous veno-venous hemodialysis was almost exclusively used (99%); effluent dose 94 mL/kg/hr [82, 110] with a procedure time limit of 24 hrs. Hypotension requiring intervention occurred during 5% of initiations. 74% of filters met prescribed time; median filter life was 19 hr [13, 23]. Common reasons for unplanned filter change were clotting (70%) and vascular access issues (24%). Survival to TC end was 84% (AKI:100%, CAKUT/ESKD: 66%). Survival to hospital discharge was 55%; 4 remain hospitalized.
Conclusion
We describe an early experience with CD in the US including ESKD. AKI outcomes remain consistent with historical CD cohorts. As more centers enroll, further experience will provide baseline information for benchmarking efforts.