PMID- 33732992
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220421
IS  - 2468-0249 (Electronic)
IS  - 2468-0249 (Linking)
VI  - 6
IP  - 3
DP  - 2021 Mar
TI  - Use of the Selective Cytopheretic Device in Critically Ill Children.
PG  - 775-784
LID - 10.1016/j.ekir.2020.12.010 [doi]
AB  - INTRODUCTION: Critically ill children with acute kidney injury (AKI) requiring 
      continuous kidney replacement therapy (CKRT) are at increased risk of death. The 
      selective cytopheretic device (SCD) promotes an immunomodulatory effect when 
      circuit ionized calcium (iCa(2+)) is maintained at <0.40 mmol/l with regional 
      citrate anticoagulation (RCA). In a randomized trial of adult patients on CRRT, 
      those treated with the SCD maintaining an iCa(2+) <0.40 mmol/l had improved 
      survival/dialysis independence. We conducted a US Food and Drug Administration 
      (FDA)-sponsored study to evaluate safety and feasibility of the SCD in 16 
      critically ill children. METHODS: Four pediatric intensive care units (ICUs) 
      enrolled children with AKI and multiorgan dysfunction receiving CKRT to receive 
      the SCD integrated post-CKRT membrane. RCA was used to achieve a circuit iCa(2+) 
      level <0.40 mmol/l. Subjects received SCD treatment for 7 days or CKRT 
      discontinuation, whichever came first. RESULTS: The FDA target enrollment of 16 
      subjects completed the study from December 2016 to February 2020. Mean age was 
      12.3 +/- 5.1 years, weight was 53.8 +/- 28.9 kg, and median Pediatric Risk of 
      Mortality II was 7 (range 2-19). Circuit iCa(2+) levels were maintained at <0.40 
      mmol/l for 90.2% of the SCD therapy time. Median SCD duration was 6 days. Fifteen 
      subjects survived SCD therapy; 12 survived to ICU discharge. All ICU survivors 
      were dialysis independent at 60 days. No SCD-related adverse events (AEs) were 
      reported. CONCLUSION: Our data demonstrate that SCD therapy is feasible and safe 
      in children who require CKRT. Although we cannot make efficacy claims, the 75% 
      survival rate and 100% renal recovery rate observed suggest a possible favorable 
      benefit-to-risk ratio.
CI  - (c) 2020 International Society of Nephrology. Published by Elsevier Inc.
FAU - Goldstein, Stuart L
AU  - Goldstein SL
AD  - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
FAU - Askenazi, David J
AU  - Askenazi DJ
AD  - University of Alabama at Birmingham, Birmingham, Alabama, USA.
FAU - Basu, Rajit K
AU  - Basu RK
AD  - Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
FAU - Selewski, David T
AU  - Selewski DT
AD  - Medical University of South Carolina, Charleston, South Carolina, USA.
FAU - Paden, Matthew L
AU  - Paden ML
AD  - Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
FAU - Krallman, Kelli A
AU  - Krallman KA
AD  - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
FAU - Kirby, Cassie L
AU  - Kirby CL
AD  - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
FAU - Mottes, Theresa A
AU  - Mottes TA
AD  - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
FAU - Terrell, Tara
AU  - Terrell T
AD  - Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
FAU - Humes, H David
AU  - Humes HD
AD  - University of Michigan, Ann Arbor, Michigan, USA.
LA  - eng
PT  - Journal Article
DEP - 20201219
PL  - United States
TA  - Kidney Int Rep
JT  - Kidney international reports
JID - 101684752
PMC - PMC7938071
OTO - NOTNLM
OT  - acute kidney injury
OT  - children
OT  - continuous kidney replacement therapy
OT  - selective cytopheretic device
EDAT- 2021/03/19 06:00
MHDA- 2021/03/19 06:01
PMCR- 2020/12/19
CRDT- 2021/03/18 06:55
PHST- 2020/11/09 00:00 [received]
PHST- 2020/12/08 00:00 [revised]
PHST- 2020/12/09 00:00 [accepted]
PHST- 2021/03/18 06:55 [entrez]
PHST- 2021/03/19 06:00 [pubmed]
PHST- 2021/03/19 06:01 [medline]
PHST- 2020/12/19 00:00 [pmc-release]
AID - S2468-0249(20)31841-6 [pii]
AID - 10.1016/j.ekir.2020.12.010 [doi]
PST - epublish
SO  - Kidney Int Rep. 2020 Dec 19;6(3):775-784. doi: 10.1016/j.ekir.2020.12.010. 
      eCollection 2021 Mar.