Safety and Efficacy of a Selective Cytopheretic Device (SCD) in Pediatric Patients With Acute Kidney Injury (AKI).

The selective cytopheretic device (SCD) is comprised of tubing, connectors and a hemofilter cartridge. The device is connected in series to commercially available Continuous Renal Replacement Therapy (CRRT) devices. Blood from the CRRT circuit is diverted after the CRRT hemofilter through to the extra capillary space (ECS) of the SCD. Blood circulates through this space and it is returned to the patient via the venous return line of the CRRT circuit. Regional citrate anticoagulation is used for the entire CRRT and SCD blood circuits.

Inclusion criteria

• A patient, or legal representative, has signed a written informed consent form.
• Must be receiving medical care in an intensive care unit (e.g., ICU, MICU, SICU, CTICU, Trauma).
• Age less than 22 years.
• Females of child bearing potential who are not pregnant (confirmed by a negative serum pregnancy test) and not lactating if recently post-partum.
• Intent to deliver full supportive care through aggressive management utilizing all available therapies for a minimum of 96 hours.
• Clinical diagnosis of AKI due to etiologies requiring CRRT (see Appendix B). AKI is defined as acute kidney injury with any one of the following:

• Increase in SCr by ≥0.3 mg/dL (≥26.5 μmol/L) within 48 hours or;
• Increase in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days or;
• Urine volume <0.5ml/kg/h for 6 hours
• At least one non-renal organ failure (defined as receiving mechanical ventilation or at least one vasoactive medication to treat hypotension) OR presence (proven or suspected) of sepsis. (Appendix C).

Exclusion criteria

• Irreversible brain damage based on available historical and clinical information.
• Presence of any organ transplant at any time.
• Acute or chronic use of circulatory support device such as LVADs, RVADs, BIVADs, ECMO(a).
• Presence of preexisting advanced chronic renal failure (i.e., ESRD) requiring CRRT prior to this episode of AKI.
• AKI occurring in the setting of burns, obstructive uropathy, allergic interstitial nephritis, acute or rapidly progressive glomerulonephritis, vasculitis, hemolytic-uremic syndrome(b), thrombotic thrombocytopenic purpura (TTP), malignant hypertension, scleroderma renal crisis, atheroembolism, functional or surgical nephrectomy, hepatorenal syndrome, cyclosporine, or tacrolimus nephrotoxicity
• Received >12hrs of CRRT during this hospital admission or prior to transfer from an outside hospital.
• Received >1 hemodialysis treatment during this hospital admission or prior to transfer from an outside hospital.
• Hospitalization >14 days during this hospital admission and or prior to transfer from an outside hospital.
• Metastatic malignancy which is actively being treated or may be treated by chemotherapy or radiation during the subsequent three-month period after study therapy.
• Chronic immunosuppression.
• HIV or AIDS.
• Severe liver failure(c).
• Current Do Not Attempt Resuscitation (DNAR), Allow Natural Death (AND), or withdrawal of care status, or anticipated change in status within the next 7 days.
• Patient is moribund or chronically debilitated for whom full supportive care is not indicated.
• Patient not expected to survive 28 days because of an irreversible medical condition. (This is not restrictive to AKI, and may include situations such as the presence of irreversible brain damage, untreatable malignancy, inoperable life threatening condition, or any condition to which therapy is regarded as futile by the PI.)
• Any medical condition that the Investigator thinks may interfere with the study objectives.
• Physician refusal.
• Dry weight of <20kg(d).
• Platelet count <30,000/mm3 at time of screening(e).
• Concurrent enrollment in another interventional clinical trial. Patients enrolled in clinical trials where only measurements and/or samples are taken (NO TEST DEVICE OR TEST DRUG USED) are allowed to participate.
• Use of any other Investigational drug or device within the previous 30 days.

• ECMO was subsequently removed as an exclusion. Two patients in the study received ECMO.
• Hemolytic uremic syndrome subsequently removed as an exclusion. One patient in the study had HUS.
• Severe liver failure was change to severe chronic liver failure during the study course.
• The lower weight limit threshold was decreased to 15 kg after consultation and approval from the US FDA.
• The thrombocytopenia exclusion removed after no observed occurrences in the first five subjects.