ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

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

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.