A miniaturised dialysis machine has been used to successfully treat a neonate with acute kidney injury, according to an article.
At this time, physicians have to adapt continuous renal replacement therapy (CRRT) machines designed and built for adults to treat babies, but that presents safety and effectiveness challenges for neonates and infants weighing less than 10 kg.
Claudio Ronco, MD, director of the Department of Nephrology, Dialysis, and Transplantation at the International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy, and colleagues designed, developed, and conducted in vitro testing of the miniaturised CRRT machine, aptly named CARPEDIEM (for Cardio-Renal Pediatric Dialysis Emergency Machine), during a 5-year period and began treatment of the first infant on August 29, 2013.
The patient was 72 hours old and in the neonatal intensive care unit with haemorrhagic shock, multiple organ dysfunction, and 63% fluid overload (2.9 kg at birth and 5.2 kg at the start of CRRT). She received more than 400 hours of treatment with the CRRT machine.
The neonatal intensive care unit discharged the patient after 30 days, when she was ‘breathing normally without supplemental oxygen, making adequate amounts of urine, and had normal liver function,’ the clinicians write. The hospital discharged her 20 days later, but she still had clinically significant chronic kidney dysfunction that did not require renal replacement therapy.
In addition to having miniaturised components, CARPEDIEM is capable of fluid control suitable for newborns and infants and can be operated at low flows and pressures and with a fluid balance accuracy. The clinicians chose the name because of its potential for use for multiple indications, including after cardiac surgery with fluid overload and renal impairment, as well as kidney injury from multiple causes.
Four independent operators tested the machine in in vitro laboratory tests before it was approved for human use after 30 months in development, the clinicians write.
In this case, the ability to use a smaller catheter for the low-weight infant precluded use of other available CRRT machines, the authors add.
Although peritoneal dialysis is the predominant treatment mode for neonates, CRRT could improve outcomes in some cases, such as critically ill infants presenting with fluid overload, with sepsis, or after abdominal surgery, the researchers write. Medscape

A team of researchers from UCLA and the University of Michigan has developed a material that could help prevent blood clots associated with catheters, heart valves, vascular grafts and other implanted biomedical devices.
Blood clots at or near implanted devices are thought to occur when the flow of nitric oxide, a naturally occurring clot-preventing agent generated in the blood vessels, is cut off. When this occurs, the devices can fail.
Some researchers have sought to solve this problem with implantable devices that gradually release nitric oxide, but their supply of the agent is necessarily limited. Instead, the UCLA

A new angiographic analysis of the CHAMPION PHOENIX trial examined the incidence and impact of stent thrombosis (ST) in patients undergoing percutaneous coronary intervention (PCI).

CHAMPION PHOENIX was a prospective, double-blind, active-controlled trial which randomised 11,145 patients to receive intravenous cangrelor or oral clopidogrel administered at the time of PCI. In a previous analysis presented at TCT 2013 and published in the Journal of the American College of Cardiology, cangrelor significantly reduced periprocedural and 30-day ischemic events in patients undergoing PCI.

In this new analysis, an independent core laboratory (CRF) blinded to the treatment performed the angiographic analysis of 10,939 of the randomised patients. Stent thrombosis was defined as the occurrence of either intraprocedural ST (IPST) or ARC defined ST (definite or probable). Adverse events were adjudicated by an independent clinical events committee.

ST occurred in 120 patients (1.1 percent) at 48 hours and in 175 patients (1.6 percent) at 30 days. The occurrence of ST at 48 hours and 30 days was associated with a marked increase in 30-day mortality (OR [95%CI] = 15.3 [8.6, 27.2], p<0.001; and 55.2 [36.6, 83.3] p<0.001, respectively). IPST, ARC acute ST (=24 hrs), and ARC subacute ST (1-30 days) occurred in 89 (0.8 percent), 32 (0.3 percent), and 60 (0.5 percent) patients respectively. Each type of ST was also associated with an increase in 30-day mortality (IPST: 17.4 [8.4, 36.1], p<0.001, ARC acute ST: 43.3 [18.1, 103.5], p<0.001, ARC sub-acute ST: 189.1, [107.9, 331.4], p<0.001). 'Regardless of the exact type of stent thrombosis, it remains associated with a high rate of death,' stated Deepak L. Bhatt, MD, MPH, Executive Director of Interventional Cardiovascular Programs at Brigham and Women

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