50 - Kidney Support in Children using Aquadex: A Prospective and Retrospective Registry

Poster Number: 50

Michelle Starr, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN, United States; Stuart L. Goldstein, Cincinnati Children's Hospital, Cincinnati, OH, United States; Shina Menon, University of Washington/Seattle Children's Hospital, Seattle, WA, United States; David Askenazi, UAB, Birmingham, AL, United States; Alex R. Constantinescu, Charles E. Schmidt College of Medicine at Florida Atlantic University, Hollywood, FL, United States; David M. Kwiatkowski, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Kidney Support therapy (KST) in small children can be technically challenging as machines designed for adult-sized patients necessitate large catheters and extracorporeal volumes. The Aquadex FlexFlow System (Nuwellis, Eden Prairie, MN) is an ultrafiltration device designed for fluid removal in adults with diuretic resistant heart failure. It has a total circuit extracorporeal volume of 33 ml, which may potentially mitigate some complications of KST in smaller children.

Objective: We sought to better characterize treatment with the Aquadex FlexFlow™ System which is being used with increasing frequency in children with AKI, fluid overload, or congenital kidney failure (CKF).

Design/Methods: We report preliminary demographic, therapy indication, and short- and long-term outcome data from this registry-based retrospective and prospective multicenter cohort of children receiving KST with Aquadex™. Patients were grouped according to weight ( < 5, 5–10, and >10 kg). We determined fluid balance (%FB) at KST initiation as the difference between dry weight and weight at KST initiation.

Results: To date, we have enrolled 82 patients (80 retrospective, 2 prospective) at 6 institutions. Patient size ranged from < 5kg (Nf45), 5-10kg (Nf12) and >10kg (Nf25), had a variety of indications, and were treated mostly in ICUs (89%).

Treatment patterns and outcomes varied by patient size. In patients < 5 kg, the primary disease was more likely to be kidney related (40%) while the primary disease in the other cohorts were more heterogenous, including cardiac (16%), kidney related (16%), and sepsis (12%). Regardless of patient size, the most common indications for KST were AKI with fluid overload (49%), fluid overload alone (32%), and CKF (11%). Patients < 5kg had higher %FB at KST initiation than 5-10 kg and >10kg (19 [5,33] vs. 13 [7,16] vs. 5 [2,25]; P=0.04), lower survival to Aquadex therapy completion (61% vs. 92% vs. 95%), P=0.004), and lower survival to hospital discharge (51% vs. 75% vs. 86%; P=0.015).Conclusion(s): We report preliminary data from an ultrafiltration device registry describing a range of therapies for children in a variety of clinical settings. KST survival and survival to hospital discharge were superior to those reported in previous US registries. Smaller patients were more likely to have higher %FB at initiation and worse outcomes. Further completion of this multicenter registry will aid in the understanding of treatment characteristics and outcomes in children on Aquadex™.
Table 1.Patient Characteristics of Children Treated with Aquadex Therapy