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Pediatric Nephrology

, Volume 31, Issue 5, pp 853–860 | Cite as

Smaller circuits for smaller patients: improving renal support therapy with Aquadex™

  • David AskenaziEmail author
  • Daryl Ingram
  • Suzanne White
  • Monica Cramer
  • Santiago Borasino
  • Carl Coghill
  • Lynn Dill
  • Frank Tenney
  • Dan Feig
  • Sahar Fathallah-Shaykh
Original Article

Abstract

Background

Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extracorporeal volume (ECV) relative to blood volume increases and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation also increases. CRRT machines with smaller ECV could reduce the risks and improve outcomes.

Methods

We present a case series of small children (n = 12) who received continuous venovenous hemofiltration (CVVH) via an Aquadex™ machine (ECV = 33 ml) with 30 ml/kg/h of prereplacement fluids at Children’s of Alabama between December 2013 and April 2015. We assessed in vitro fluid precision using the adapted continuous veno-venous hemofiltration (CVVH) system.

Results

We used 101 circuits over 261 days to provide CVVH for 12 children (median age 30 days; median weight 3.4 kg). Median CVVH duration was 14.5 days [interquartile range (IQR) = 10; 22.8 days]. Most circuits were routinely changed after 72 h. Five of 101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient cases of hypothermia, three puncture-site bleedings, one systemic bleed, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from the intensive care unit; six of them (50 %) were discharged home.

Conclusions

CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe, and efficient renal support to small, critically ill infants.

Keywords

Renal support therapy Continuous venovenous hemofiltration Aquadex™ Dialysis Neonate Acute kidney injury Fluid overload CRRT 

Notes

Compliance with ethical standards

All procedures performed involving human participants were in accordance with the ethical standards of the Institutional Review Board at the University of Alabama at Birmingham, as well as with the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent for CRRT was obtained after the benefits and risks were discussed with the family, in accordance with policies for all acute RRT procedures (hemodialysis, peritoneal dialysis, CRRT) at our institution. The University of Alabama at Birmingham Institutional Review Board approved this retrospective report of the case series, with waiver of informed research consent..

Statement of financial support

Research reported in this publication was supported by the Pediatric and Infant Center for Acute Nephrology (PICAN), which is sponsored by Children’s of Alabama Hospital and the University of Alabama at Birmingham’s School of Medicine, Department of Pediatrics and Center for Clinical and Translational Science (CCTS) under award number UL1TR00165.

Disclosure of potential conflicts of interest

Dr. Askenazi is a speaker for the Acute Kidney Injury (AKI) Foundation.

References

  1. 1.
    Jetton JG, Askenazi DJ (2012) Update on acute kidney injury in the neonate. Curr Opin Pediatr 24:191–196CrossRefPubMedGoogle Scholar
  2. 2.
    Askenazi DJ, Goldstein SL, Koralkar R, Fortenberry J, Baum M, Hackbarth R, Blowey D, Bunchman TE, Brophy PD, Symons J, Chua A, Flores F, Somers MJ (2013) Continuous renal replacement therapy for children </=10 kg: a report from the prospective pediatric continuous renal replacement therapy registry. J Pediatr 162:587–592.e3CrossRefPubMedGoogle Scholar
  3. 3.
    Ronco C, Garzotto F, Brendolan A, Zanella M, Bellettato M, Vedovato S, Chiarenza F, Ricci Z, Goldstein SL (2014) Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM). Lancet 383:1807–1813CrossRefPubMedGoogle Scholar
  4. 4.
    Coulthard MG, Crosier J, Griffiths C, Smith J, Drinnan M, Whitaker M, Beckwith R, Matthews JN, Flecknell P, Lambert HJ (2014) Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol 29:1873–1881CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Bridges BC, Askenazi DJ, Smith J, Goldstein SL (2012) Pediatric renal replacement therapy in the intensive care unit. Blood Purif 34:138–148CrossRefPubMedGoogle Scholar
  6. 6.
    Spinale JM, Laskin BL, Sondheimer N, Swartz SJ, Goldstein SL (2013) High-dose continuous renal replacement therapy for neonatal hyperammonemia. Pediatr Nephrol 28:983–986CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Hothi DK (2014) Designing technology to meet the therapeutic demands of acute renal injury in neonates and small infants. Pediatr Nephrol 29:1869–1871CrossRefPubMedGoogle Scholar
  8. 8.
    Garzotto F, Zanella M, Ronco C (2014) The evolution of pediatric continuous renal replacement therapy. Nephron Clin Pract 127:172–175CrossRefPubMedGoogle Scholar
  9. 9.
    Modem V, Thompson M, Gollhofer D, Dhar AV, Quigley R (2014) Timing of continuous renal replacement therapy and mortality in critically ill children. Crit Care Med 42:943–953CrossRefPubMedGoogle Scholar
  10. 10.
    Wang X, Jie Yuan W (2012) Timing of initiation of renal replacement therapy in acute kidney injury: a systematic review and meta-analysis. Ren Fail 34:396–402CrossRefPubMedGoogle Scholar

Copyright information

© IPNA 2015

Authors and Affiliations

  • David Askenazi
    • 1
    Email author
  • Daryl Ingram
    • 2
  • Suzanne White
    • 2
  • Monica Cramer
    • 1
  • Santiago Borasino
    • 3
  • Carl Coghill
    • 4
  • Lynn Dill
    • 1
    • 2
  • Frank Tenney
    • 1
  • Dan Feig
    • 1
  • Sahar Fathallah-Shaykh
    • 1
  1. 1.Division of Pediatric Nephrology, Department of PediatricsUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Renal Care Center, Children’s of Alabama HospitalBirminghamUSA
  3. 3.Division of Pediatric Intensive Care UnitUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Divisiion of NeonatologyUniversity of Alabama at BirminghamBirminghamUSA

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