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Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system

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Abstract

Background

Infants with kidney failure (KF) demonstrate poor growth partly due to obligate fluid and protein restrictions. Delivery of liberalized nutrition on continuous kidney replacement therapy (CKRT) is impacted by clinical instability, technical dialysis challenges, solute clearance, and nitrogen balance. We analyzed delivered nutrition and growth in infants receiving CKRT with the Cardio-Renal, Pediatric Dialysis Emergency Machine (Carpediem™).

Methods

Single-center observational study of infants receiving CKRT with the Carpediem™ between June 1 and December 31, 2021. We collected prospective circuit characteristics, delivered nutrition, anthropometric measurements, and illness severity Score for Neonatal Acute Physiology-II. As a surrogate to normalized protein catabolic rate in maintenance hemodialysis, we calculated normalized protein nitrogen appearance (nPNA) using the Randerson II continuous dialysis model. Descriptive statistics, Spearman correlation coefficient, Mann Whitney, Wilcoxon signed rank, receiver operating characteristic curves, and Kruskal–Wallis analysis were performed using SAS version 9.4.

Results

Eight infants received 31.9 (22.0, 49.7) days of CKRT using mostly (90%) regional citrate anticoagulation. Delivered nutritional volume, protein, total calories, enteral calories, nPNA, and nitrogen balance increased on CKRT. Using parenteral nutrition, 90 ml/kg/day should meet caloric and protein needs. Following initial weight loss of likely fluid overload, exploratory sensitivity analysis suggests weight gain occurred after 14 days of CKRT. Despite adequate nutritional delivery, goal weight (z-score = 0) and growth velocity were not achieved until 6 months after CKRT start. Most (5 infants, 62.5%) survived and transitioned to peritoneal dialysis (PD).

Conclusions

Carpediem™ is a safe and efficacious bridge to PD in neonatal KF. Growth velocity of infants on CKRT appears delayed despite delivery of adequate calories and protein.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the Baylor College of Medicine IRB on reasonable request.

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Funding

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [1R13HD104433-01].

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Kim T. Vuong, Molly R. Vega, Lauren Casey, Sarah J. Swartz, Poyyapakkam Srivaths, Ayse Akcan Arikan & Catherine Joseph

  2. Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Scott W. Osborne & Christopher J. Rhee

  3. Division of Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX, USA

    Ayse Akcan Arikan

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  1. Kim T. Vuong
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Correspondence to Kim T. Vuong.

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Vuong, K.T., Vega, M.R., Casey, L. et al. Clearance and nutrition in neonatal continuous kidney replacement therapy using the Carpediem™ system. Pediatr Nephrol 39, 1937–1950 (2024). https://doi.org/10.1007/s00467-023-06237-w

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