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Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device

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Abstract

Background

Providing extracorporeal renal support to neonates and infants involves a number of technical and clinical issues, possibly discouraging early utilization. This report aims to describe a multicenter experience of continuous kidney replacement therapy (CKRT) delivery to small infants using a device specifically designed for this age group.

Methods

A retrospective cohort analysis of all patients treated with the Carpediem™ machine (Bellco-Medtronic, Mirandola, Italy) in 6 centers between June 2013 and December 2016.

Results

Twenty-six neonates and small infants received 165 CKRT sessions in convective modality. Median age at neonatal intensive care unit admission 1 day (IQR 1–11), median body weight 2.9 kg (IQR 2.2–3.6). Median circuit duration 14 h (IQR 10–22), with delivered/prescribed time ratio of 84%. CKRT was conducted using 4 Fr (27%), 5 Fr (35%), 6.5 Fr (11%), and 7 Fr (3%) vascular access, and with umbilical and peripheral accesses (11% each) allowing overall median blood flow of 4.5 ml/kg/min (IQR 3.4–6) and median effluent flow rate 35 ml/kg/h (IQR 28–42). Circuits were primed with normal saline in 58% of treatments, colloids in 31%, and packed red blood cells in 11%. No serious adverse events directly related to machine application were reported by any center. Twenty-five (96%) patients survived their CKRT course and 13 patients (50%) survived to ICU discharge.

Conclusions

CKRT in neonates was easy to initiate and conduct when performed with small central vascular accesses coupled with this device. A dedicated technology for infant CKRT delivery enables patients to be safely treated avoiding technical complications.

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Author information

Author notes

  1. Francesco Garzotto and Enrico Vidal contributed equally to this work.

Authors and Affiliations

  1. Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy

    Francesco Garzotto

  2. Division of Pediatrics, Department of Medicine, University Hospital of Udine, University of Udine, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy

    Enrico Vidal

  3. Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy

    Zaccaria Ricci

  4. Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Fabio Paglialonga

  5. Pediatric Nephrology and Dialysis Unit, Children’s Hospital Giovanni XXIII, Bari, Italy

    Mario Giordano

  6. Neonatology and NICU Section, Department of Biomedical Sciences and Human Oncology (DIMO), University of Bari, Bari, Italy

    Nicola Laforgia

  7. Pediatric Nephrology Unit, Città della Salute e della Scienza di Torino, Regina Margherita Children’s Hospital, Turin, Italy

    Licia Peruzzi

  8. Pediatric Unit, San Bortolo Hospital, Vicenza, Italy

    Massimo Bellettato

  9. Nephrology, Dialysis and Transplant Unit, Department of Woman’s and Child’s Health, University-Hospital of Padova, Padova, Italy

    Luisa Murer

  10. International Renal Research Institute of Vicenza, Vicenza, Italy

    Claudio Ronco

  11. Department of Nephrology, Dialysis, and Transplantation, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  12. Department of Medicine (DIMED), University of Padova, Padova, Italy

    Claudio Ronco

Authors
  1. Francesco Garzotto
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  2. Enrico Vidal
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  3. Zaccaria Ricci
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  4. Fabio Paglialonga
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  5. Mario Giordano
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  6. Nicola Laforgia
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  7. Licia Peruzzi
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  8. Massimo Bellettato
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  9. Luisa Murer
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  10. Claudio Ronco
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Corresponding author

Correspondence to Enrico Vidal.

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Conflict of interest

Prof. Ronco received speakers’ honoraria from GE Healthcare, Fresenius, ESTOR, and B. Braun. He also received compensation and consulted for Astute Medical, OCD, Biomérieux, Baxter, Jafron Biomedical Co., and Asahi Medical. All other authors declare that they have no conflict of interest.

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Garzotto, F., Vidal, E., Ricci, Z. et al. Continuous kidney replacement therapy in critically ill neonates and infants: a retrospective analysis of clinical results with a dedicated device. Pediatr Nephrol 35, 1699–1705 (2020). https://doi.org/10.1007/s00467-020-04562-y

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  • DOI: https://doi.org/10.1007/s00467-020-04562-y

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