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BIRMINGHAM – Using a novel approach and a machine designed to remove fluid from adults with heart failure, an article published in the Clinical Journal of the American Society of Nephrology (CJASN) reports higher survival rates and lower complications than previous studies.
Pediatric use of the Aquadex FlexFlow System, intended for fluid removal in adults with diuretic resistant heart failure, was developed at Children’s of Alabama in 2016. The CJASN’s August issue describes the first 199 patients cared for at three institutions – Children’s, Cincinnati Children’s and Seattle Children’s. David Askenazi, M.D., a professor in the University of Alabama at Birmingham’s Department of Pediatrics and director of the UAB and Children’s of Alabama’s Pediatric and Infant Center for Acute Nephrology, was the study’s senior author. The multiple-center, cohort study evaluated 119 admissions and more than 800 circuits.
“Prior to the use of the Aquadex, there were high rates of patient complications and technical challenges that limited our ability to provide support to small children with kidney failure and excess fluid accumulation,” Askenazi said. “This machine allows us to do the job of the kidneys for the baby, without the baby even knowing that it’s happening.”
Dialysis is a medical treatment that can assume the job of filtering blood when the kidneys can't do it properly. Critically ill neonates who receive continuous kidney replacement treatment are difficult to dialyze, Askenazi said, and acute kidney illness and fluid overload are common and associated with morbidity and mortality in critically ill neonates and children.
The study suggests that the adapted machine can successfully be adjusted for use on babies who weigh as little as 2 pounds and in those who are critically ill. The Clinical Journal of the American Society of Nephrology is an official publication of the American Society of Nephrology.
"Aquadex has given us the ability to safely dialyze babies from birth,” said Kara Short, a Pediatric Nephrology nurse at Children’s. “For our babies born with diseased or absent kidneys, Aquadex has given them a chance at life, because in the past, the machines to treat these patients came with too much risk."