This isn't your typical “seize the day.” The cardio-renal pediatric dialysis emergency machine is a fairly new development for pediatric patients.
Acute kidney injury is the sudden reduction in blood and/or oxygen flow to the kidneys, resulting in a decreased glomerular filtration rate and urine output. Blood filtration is crucial for organ function and with kidney failure, organ decline can be rapid. Before the Carpediem system, mortality rate for severe pediatric AKI was at least 50% (Ronco et al., 2012). Renal replacement therapy (RRT) is indicated to prevent fluid build up, but we adapted adult dialysis machines to much smaller and fragile patients. Up until 2014, there was no true pediatric RRT system. The FDA authorized the Carpediem system in 2020 (Cincinnati Children’s, 2021). Using traditional machines for pediatric patients presents several challenges. There was difficulty with trying to get the accurate blood flow and oftentimes machines have varied “reaction times” before fluid balance error occurs (Ronco et al., 2012).
The Carpediem system is a technological advancement that has improved the conditions of pediatric patients in critical care. According to studies in the EU, there is a 97% survival rate at the end of treatment (Medtronic, n.d.). With a machine that connects to smaller catheters, closely monitors fluid balance for patients under 10kgs, there is reduced blood vessel damage and infection.
Pediatric AKI is considered an orphan disease because it affects fewer than 200,000. This presents some ethical issues for this condition and other rare diseases because research funding and therapy development is much lower. This affects not only treatment but preventative measures as well. Because symptoms of pediatric AKI can appear in the least a course of hours, treatment must be swift. Now pediatric AKI mortality is much lower, but there are still hurdles to overcome with its prevention.
Dijken, C., Fjellman-Wiklund, A., & Hildingsson, C. (2008). Low back pain, lifestyle factors and physical activity: A population based-study. Journal of Rehabilitation Medicine, 40(10), 864–869. https://doi.org/10.2340/16501977-0273
Home. Cincinnati Childrens. (n.d.). Retrieved September 29, 2022, from https://www.cincinnatichildrens.org/news/release/2021/carpediem
Ronco, C., Garzotto, F., & Ricci, Z. (2012). CA.R.PE.DI.E.M. (cardio–renal pediatric dialysis emergency machine): Evolution of continuous renal replacement therapies in infants. A personal journey. Pediatric Nephrology, 27(8), 1203–1211. https://doi.org/10.1007/s00467-012-2179-8
Your title really caught my attention and I enjoyed learning about Acute Kidney Injury in pediatric patients. I know that it is difficult to get funding for orphan diseases, but do you think that is it more important to get funding for treatments of this disease or funding to catch and prevent this disease early on? I think both are valid uses of research and funding. It may even be difficult to get funding for preventative and diagnostic research because the disease is so uncommon. However, if you would like to look into the ideas of research on diagnosing and preventative measures I found an article that did research on just that. The article used a machine learning model that could potentially prevent or reduce AKI by using preventative measures like medication adjustment.
ReplyDeleteHere is the link to the article:
Dong J, Feng T, Thapa-Chhetry B, Cho BG, Shum T, Inwald DP, Newth CJL, Vaidya VU. Machine learning model for early prediction of acute kidney injury (AKI) in pediatric critical care. Crit Care. 2021 Aug 10;25(1):288. doi: 10.1186/s13054-021-03724-0. PMID: 34376222; PMCID: PMC8353807.
Hey! I really enjoyed reading and learning about AKI. Actually, this past summer I was an intern at Children's Hospital CO. at the endo/peds floor and this topic was mentioned at least twice a day. I learn a lot about Diabetic Kidney disease and Chronic Kidney Disease in children. My mentor has ongoing research studies about the topic you shared with us and many more approaches to prevent diabetic kidney disease. I'll leave the link to his website that has all of his publications on the topic. https://www.bjornstadlab.org/ After learning about this new approached to medicine, it is exciting to see how treatments are evolving quickly and hopefully they find permanent solutions for diseases like this.
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