CARPEDIEM® for continuous kidney replacement therapy in neonates and small infants: a French multicenter retrospective study

The Cardio-Renal Pediatric Dialysis Emergency Machine (CA.R.P.E.D.I.E.M.®) device is a continuous kidney replacement therapy (CKRT) equipment dedicated to neonates and small infants. This study aimed to assess the effectiveness, feasibility, outcomes, and technical considerations relating to CARPEDIEM® use.

This retrospective multicenter study included 19 newborns and six infants receiving CARPEDIEM® in five French pediatric and neonatal intensive care units. Laboratory parameters were collected at the initiation and end of the first CARPEDIEM® session. Results are presented as median [IQR] (range).

At initiation, age was 4 days [2–13] (1–1134) with a body weight of 3.3 kg [2.5–4] (1.3–11.1). Overall, 131 sessions and 2125 h of treatment were performed. Treatment duration per patient was 42 h [24–91] (8–557). Continuous veno-venous hemofiltration (CVVH) was performed in 20 children. Blood flow rate was 8 mL/kg/min [6–9] (3–16). The effluent flow rate for CVVH was 74 mL/kg/h [43–99] (28–125) and net ultrafiltration (UF) 6 mL/kg/h [2–8] (1–12). In the five children treated by hemodialysis, the blood and dialysate flow rates were 6 mL/kg/min [5–7] (4–7) and 600 mL/h [300–600] (120–600), respectively, while session duration was 8 h [6–12] (2–24). Most infants required a catheter between 4.5 and 6.5 French. Hemodynamic instability with a need for volume replacement occurred in 31 sessions (23%). Thrombocytopenia was observed in 29 sessions (22%). No hemorrhage occurred; all the patients survived the sessions, but only eight patients (32%) were alive at hospital discharge.

These data confirm that the use of CARPEDIEM® is safe and effective in critically ill neonates and infants.