Continuous kidney replacement therapy with CARPEDIEM of premature and low birth weight neonates from the French registry.

BACKGROUND

Acute kidney injury (AKI) affects 30% of hospitalized pediatric patients, with high mortality in neonates. The Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) is a continuous kidney replacement therapy (CKRT) device designed for infants weighing 2.5-9.9 kg.

METHODS

We retrospectively evaluated the technical feasibility, efficacy regarding solute and fluid removal, tolerability and patient outcomes of CKRT with CARPEDIEM in preterm and low birth weight (LBW) neonates (< 2.5 kg) with AKI, treated in six French pediatric intensive care units.

RESULTS

Ten neonates with a median gestational age of 31 [interquartile 29-32] (range 25-38) weeks and a birth weight of 1.1 [IQ 1.0-1.7] (0.6-2.0) kilograms received continuous veno-venous hemofiltration (CVVH) during 22 sessions. CVVH was initiated at a median age of 6 [2-12] (1-72) days and a weight of 1.9 [1.5-2.4] (1.3-2.8) kg. All CVVH sessions achieved efficient blood purification. At CVVH initiation fluid overload was 29 [21-39] (11-68)% and improved until the end of treatment to 16[8-18] (0-40)% (p = 0.04). Thrombocytopenia, requiring platelet transfusion, and hypotensive episodes were the main complications observed in 14 and 13 sessions. No deaths occurred during the CARPEDIEM treatment but all except one neonate died 6 [1-9] (1-63) days later, mainly due to multi-organ failure or ethical considerations linked to severe brain injury.

CONCLUSION

CVVH using CARPEDIEM is technically feasible and effective in neonates with a birth weight below 2.5 kg with AKI and multi-organ dysfunction with the potential to improve clinical management. Further studies are needed to define adequate timing, dosing, and the impact on patient outcome.