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CARPEDIEM® for continuous kidney replacement therapy in neonates and small infants: a French multicenter retrospective study

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Abstract

Background

The Cardio-Renal Pediatric Dialysis Emergency Machine (CA.R.P.E.D.I.E.M.®) device is a continuous kidney replacement therapy (CKRT) equipment dedicated to neonates and small infants. This study aimed to assess the effectiveness, feasibility, outcomes, and technical considerations relating to CARPEDIEM® use.

Methods

This retrospective multicenter study included 19 newborns and six infants receiving CARPEDIEM® in five French pediatric and neonatal intensive care units. Laboratory parameters were collected at the initiation and end of the first CARPEDIEM® session. Results are presented as median [IQR] (range).

Results

At initiation, age was 4 days [2–13] (1–1134) with a body weight of 3.3 kg [2.5–4] (1.3–11.1). Overall, 131 sessions and 2125 h of treatment were performed. Treatment duration per patient was 42 h [24–91] (8–557). Continuous veno-venous hemofiltration (CVVH) was performed in 20 children. Blood flow rate was 8 mL/kg/min [6–9] (3–16). The effluent flow rate for CVVH was 74 mL/kg/h [43–99] (28–125) and net ultrafiltration (UF) 6 mL/kg/h [2–8] (1–12). In the five children treated by hemodialysis, the blood and dialysate flow rates were 6 mL/kg/min [5–7] (4–7) and 600 mL/h [300–600] (120–600), respectively, while session duration was 8 h [6–12] (2–24). Most infants required a catheter between 4.5 and 6.5 French. Hemodynamic instability with a need for volume replacement occurred in 31 sessions (23%). Thrombocytopenia was observed in 29 sessions (22%). No hemorrhage occurred; all the patients survived the sessions, but only eight patients (32%) were alive at hospital discharge.

Conclusions

These data confirm that the use of CARPEDIEM® is safe and effective in critically ill neonates and infants.

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Data availability

The data is available if requested from the corresponding author.

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Acknowledgements

The authors would like to thank the physicians involved in this clinical study aiming at improving our management practices with the use of CARPEDIEM®. The authors would also like to thank Véréna Landel (Direction de la Recherche en Santé, HCL) for help in manuscript preparation.

Funding

D. De Luca has received research assistance and speaker fees from MEDTRONIC Inc., outside of the present work.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Archet 2, CHU de Nice, Hôpital Archet, 151 Route Saint-Antoine de Ginestière, 06200, Nice, France

    Jennifer Battista, Camille Faudeux & Julie Bernardor

  2. Division of Pediatrics and Neonatal Critical Care, “A. Béclère” Medical Centre, Paris Saclay University Hospitals, APHP, and the Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France

    Daniele De Luca & Giulia Regiroli

  3. Department of Intensive Care and Neonatal Medecine, CHU de Nice, Hôpital Archet, Nice, France

    Sergio Eleni Dit Trolli

  4. Pediatric Nephrology Unit, Reference Center for Rare Renal Diseases, SORARE, Bordeaux University Hospital, Bordeaux, France

    Lise Allard

  5. Reference Center for Rare Renal Diseases, Pediatric Nephrology-Rheumatology-Dermatology Unit and INSERM 1033 Unit, Hospices Civils de Lyon, Femme Mere Enfant Hospital, Lyon 1 University, Bron, France

    Justine Bacchetta, Bruno Ranchin & Julie Bernardor

  6. Pediatric Intensive Care Unit, Hôpital Louis Pradel, Lyon 1 University, Lyon, France

    Nourredine Bouhamri

  7. Pediatric Nephrology, Internal Medicine and Rheumatology, Southwest Renal Rare Diseases Centre (SORARE), University Children’s Hospital, Toulouse, France

    Carole Enoch

  8. Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France

    Julie Guichoux

  9. Paediatric Intensive Care Unit, Mother and Children University Hospital, Hospices Civils de Lyon, Bron, France

    Etienne Javouhey & Karine Kolev

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  1. Jennifer Battista
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  2. Daniele De Luca
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Corresponding author

Correspondence to Julie Bernardor.

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Ethics

The study was approved by an ethics committee (Comité d’Ethique des Recherches non Interventionelles Université Côte d’Azur, session 23 September 2020, approval N°2020–68) and respected all local and European relevant regulations. This study was performed with the appropriate participants’ informed consent in compliance with the Helsinki Declaration.

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Battista, J., De Luca, D., Eleni Dit Trolli, S. et al. CARPEDIEM® for continuous kidney replacement therapy in neonates and small infants: a French multicenter retrospective study. Pediatr Nephrol 38, 2827–2837 (2023). https://doi.org/10.1007/s00467-022-05871-0

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