240 - Understanding multicenter use of a dedicated Neonatal CRRT Machine in the United States

The CarpediemÔ device (CD) is a dedicated infant dialysis device designed to provide continuous renal replacement therapy (CRRT) safely. As we anticipate its use, to be important, yet rare, the need for multicenter collaboration to understand best practice is necessary. We created a multicenter multidisciplinary quality improvement and research registry, Improving Carpediem Outcomes in Neonates and Infants through Collaboration (ICONIC), dedicated to informing best practices and treatment strategies to understand and improve outcomes in this population.

Objective:

To understand early use and outcomes infants who received CD in the United States (US). 

Design/Methods: This ICONIC study (NCT05161078) prospectively assesses infants receiving CD. Data related, but not limited to, demographics, diagnosis, fluid balance, renal function, CRRT prescription, treatment courses and outcomes are recorded. Treatment courses are defined as < 72 hours between subject CD procedures and treatment course survival is considered survival to 72 hours post CD discontinuation. Variables are described by median and interquartile ranges [IQR] or percent (%).

Results:

Three centers have entered 27 subjects into the research registry, who underwent 36 treatment courses utilizing 514 filters. Median weight at admission was 3.4 kg [IQR: 2.6, 5.0 kg]. The commonest catheter characteristics were size 7.5 Fr (32%), tunneled catheter (49%), and internal jugular placement (80%). Median catheter insertions per subject was two. Treatment start was most often the neonatal intensive care unit (ICU) (72%) with congenital anomalies of the kidney and urinary tract accounting for 42% of indications. Weight-based fluid accumulation at treatment start was 23%. Regional citrate anticoagulation was used for 55% filters. 64% of circuits were initiated with a blood prime. CVVH was the most common modality (99%). Hypotension requiring intervention at procedure start occurred 24 times (5%). Filter survival to planned treatment time occurred 73% of the time. Unplanned filter change was indicated most for clotting (70%) followed by vascular access issues (24%). Two subjects have incomplete ICU discharge data. Survival to treatment course end was 81%, with 56% overall survival to discharge. Most common primary cause of death was pulmonary hypoplasia (40%).  

Conclusion(s):

We present initial results in the US of subjects receiving dialysis via a dedicated infant CRRT device. Outcomes remain consistent with historical cohorts. As more centers enroll, understanding practice and prescription patterns will provide key information for benchmarking efforts.