Aquapheresis Therapy for the Youngest Children with Kidney Disease

NICU Aquapheresis Leadership team

The NICU Aquapheresis Leadership Team – Dr. Jennifer Charlton, Sarah Burnett PNP-BC, Dr. Jonathan Swanson, Dr. Agnes Swiatecka-Urban

The UVA Children’s Hospital Aquapheresis therapy program, launched on February 1, 2023, is the answer to the challenges of treating neonates and infants with fluid overload resistant to diuretic therapy, renal insufficiency, or renal failure. “We are incredibly excited to be able to offer this treatment to our patients here at UVA and throughout Virginia and the mid-Atlantic. It is another example of the the great collaborative efforts that occur at UVA Children’s,” said Dr. Jonathan Swanson, NICU Medical Director.

Peritoneal dialysis, the preferred modality for chronic renal replacement in children, is inadequate for most acutely ill children in whom continuous renal replacement therapy (CRRT) is favored. However, the CRRT equipment used in acutely ill older children and adults is too large for the youngest and smallest patients. As a result, despite having higher rates of acute kidney injury than most critically ill older populations, neonates receive CRRT infrequently and only if they have advanced kidney injury and severe fluid overload. As a result, the outcomes of critically ill neonates and infants are negatively impacted by the disease severity that ensues with delayed initiation of CRRT and the extra-corporeal volume of the CRRT equipment required. CRRT machines with smaller extra-corporeal volumes reduce the risks associated with the therapy and improve outcomes.

The Aquadex FlexFlow® system which has been recently introduced to the NICU at the University of Virginia, is designed to mitigate the risks from large volumes by employing a continuous veno-venous hemofiltration device using a small circuit volume of 33 ml allowing slower blood flow rates. This system uses small dialysis catheters, for example, a 6 Fr power PICC, which is adequate for and tolerated by the younger patients. Complications of this therapy in small patients, including transient hemodynamic instability, clotting, catheter malfunction, and minor bleeding, are less frequent and less severe than with other hemodialysis equipment.

Aquadex FlexFlow® system can also be used to bridge the renal replacement therapy for patients who would eventually transition to peritoneal dialysis.

The Aquapheresis therapy via the Aquadex FlexFlow® system is administered via a collaborative effort between Pediatric Nephrology, Neonatology, Pediatric Critical Care, and the Renal Unit at UVA Children’s Hospital.