Blood purification · 2025
Use of the Selective Cytopheretic Device with Continuous Renal Replacement Therapy in Children: A Comparison of Contemporary Cohorts.
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Stanski Natalja L, Seo JangDong, Jenkins Todd, Krallman Kelli A, Menon Shina, Humes H David, Askenazi David J, Basu Rajit K, Akcan-Arikan Ayse, Goldstein Stuart L, Gist Katja M, WE-ROCK Investigators
Аннотация
INTRODUCTION: The selective cytopheretic device (SCD) is a cell-directed extracorporeal therapy approved for use in children with acute kidney injury (AKI) receiving continuous renal replacement therapy (CRRT) with sepsis/sepsis-like conditions. We compared outcomes for children treated with SCD to a contemporary cohort of children treated with CRRT alone.
METHODS: Secondary analysis and comparison of patients ≤22 years old and ≥10 kg from a multicenter registry of patients receiving CRRT for AKI and/or fluid overload (WE-ROCK; 2015-2021) to patients from two multicenter, prospective, interventional studies of children with AKI and multiple organ dysfunction (MODS) receiving SCD (SCD-PED-01/SCD-PED-02; 2016-2022).
RESULTS: Eighteen patients in the SCD cohort were compared to 178 in the CRRT cohort. There were no differences between cohorts at CRRT ± SCD initiation. SCD patients had shorter CRRT duration (6 [3, 11] vs. 10 [5, 18] days, p = 0.013) and shorter ICU length of stay (LOS) in survivors (16 [11, 25] vs. 27 [16, 46] days, p = 0.012). Survival to ICU discharge or day 60 was 94% in the SCD cohort vs. 74% in the CRRT cohort (p = 0.079). A Bayesian analysis demonstrated a >99% probability of improved survival with SCD. A sub-analysis in septic patients demonstrated greater survival (100% vs. 69%, p = 0.032), shorter CRRT duration (5 [3, 7] vs. 11 [6, 17] days, p = 0.006) and reduced ICU LOS in survivors (21 [10, 25] vs. 27 [16, 45] days, p = 0.027) in SCD-treated patients.
CONCLUSIONS: The addition of SCD therapy in children with AKI and MODS receiving CRRT may be beneficial, though larger prospective studies are needed.
METHODS: Secondary analysis and comparison of patients ≤22 years old and ≥10 kg from a multicenter registry of patients receiving CRRT for AKI and/or fluid overload (WE-ROCK; 2015-2021) to patients from two multicenter, prospective, interventional studies of children with AKI and multiple organ dysfunction (MODS) receiving SCD (SCD-PED-01/SCD-PED-02; 2016-2022).
RESULTS: Eighteen patients in the SCD cohort were compared to 178 in the CRRT cohort. There were no differences between cohorts at CRRT ± SCD initiation. SCD patients had shorter CRRT duration (6 [3, 11] vs. 10 [5, 18] days, p = 0.013) and shorter ICU length of stay (LOS) in survivors (16 [11, 25] vs. 27 [16, 46] days, p = 0.012). Survival to ICU discharge or day 60 was 94% in the SCD cohort vs. 74% in the CRRT cohort (p = 0.079). A Bayesian analysis demonstrated a >99% probability of improved survival with SCD. A sub-analysis in septic patients demonstrated greater survival (100% vs. 69%, p = 0.032), shorter CRRT duration (5 [3, 7] vs. 11 [6, 17] days, p = 0.006) and reduced ICU LOS in survivors (21 [10, 25] vs. 27 [16, 45] days, p = 0.027) in SCD-treated patients.
CONCLUSIONS: The addition of SCD therapy in children with AKI and MODS receiving CRRT may be beneficial, though larger prospective studies are needed.