The Infant KIdney Dialysis and Utrafiltration (I-KID) Study: A Stepped-Wedge Cluster-Randomized Study in Infants, Comparing Peritoneal Dialysis, Continuous Venovenous Hemofiltration, and Newcastle Infant Dialysis Ultrafiltration System, a Novel Infant Hemodialysis Device

Heather Lambert*, Shaun Hiu, Malcolm G. Coulthard, John N.S. Matthews, Eva Maria Holstein, Jean Crosier, Rachel Agbeko, Thomas Brick, Heather Duncan, David Grant, Quen Mok, Andrew Gustaf Nyman, John Pappachan, Chris Boucher, Joe Bulmer, Denise Chisholm, Kirsten Cromie, Victoria Emmet, Richard G. Feltbower, Arunoday GhoseMichael Grayling, Rebecca Harrison, Ciara A. Kennedy, Elaine Mccoll, Kevin Morris, Lee Norman, Julie Office, Roger Parslow, Christine Pattinson, Shriya Sharma, Jonathan Smith, Alison Steel, Rachel Steel, Jayne Straker, Lamprini Vrana, Jenn Walker, Paul Wellman, Mike Whitaker, Jim Wightman, Nina Wilson, Lucy Wirz, Ruth Wood

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)

Abstract

Objectives: Renal replacement therapy (RRT) options are limited for small babies because of lack of available technology. We investigated the precision of ultrafiltration, biochemical clearances, clinical efficacy, outcomes, and safety profile for a novel non-Conformité Européenne-marked hemodialysis device for babies under 8 kg, the Newcastle Infant Dialysis Ultrafiltration System (NIDUS), compared with the current options of peritoneal dialysis (PD) or continuous venovenous hemofiltration (CVVH). Design: Nonblinded cluster-randomized cross-sectional stepped-wedge design with four periods, three sequences, and two clusters per sequence. Setting: Clusters were six U.K. PICUs. Patients: Babies less than 8 kg requiring RRT for fluid overload or biochemical disturbance. Interventions: In controls, RRT was delivered by PD or CVVH, and in interventions, NIDUS was used. The primary outcome was precision of ultrafiltration compared with prescription; secondary outcomes included biochemical clearances. Measurements and Main Results: At closure, 97 participants were recruited from the six PICUs (62 control and 35 intervention). The primary outcome, obtained from 62 control and 21 intervention patients, showed that ultrafiltration with NIDUS was closer to that prescribed than with control: sd controls, 18.75, intervention, 2.95 (mL/hr); adjusted ratio, 0.13; 95% CI, 0.03-0.71; p = 0.018. Creatinine clearance was smallest and least variable for PD (mean, sd) = (0.08, 0.03) mL/min/kg, larger for NIDUS (0.46, 0.30), and largest for CVVH (1.20, 0.72). Adverse events were reported in all groups. In this critically ill population with multiple organ failure, mortality was lowest for PD and highest for CVVH, with NIDUS in between. Conclusions: NIDUS delivers accurate, controllable fluid removal and adequate clearances, indicating that it has important potential alongside other modalities for infant RRT.

Original languageEnglish
Pages (from-to)604-613
Number of pages10
JournalPediatric Critical Care Medicine
Volume24
Issue number7
DOIs
Publication statusPublished - 1 Jul 2023

Bibliographical note

Publisher Copyright:
Copyright © 2023 The Author(s).

Keywords

  • acute kidney injury
  • dialysis
  • infant
  • renal failure
  • renal replacement therapy
  • ultrafiltration

Fingerprint

Dive into the research topics of 'The Infant KIdney Dialysis and Utrafiltration (I-KID) Study: A Stepped-Wedge Cluster-Randomized Study in Infants, Comparing Peritoneal Dialysis, Continuous Venovenous Hemofiltration, and Newcastle Infant Dialysis Ultrafiltration System, a Novel Infant Hemodialysis Device'. Together they form a unique fingerprint.

Cite this