Comprehensive Therapy Options For Acute Kidney Injuries

The Center for Acute Care Nephrology offers comprehensive therapy options when treating acute kidney injury needs. Armed with the most advanced therapies, the CACN adapts treatments to accommodate a patient’s conditions. Through our collaborative work with partners at Cincinnati Children’s and other institutions, the CACN team members are able to provide the following services: 

Acute Renal Replacement Therapies

Acute renal replacement therapies can be initiated for acute kidney injury, fluid overload and/or sepsis. The collaborative decision to start renal replacement therapy is based on many factors and helps determine which therapy can be started.

• Acute Peritoneal Dialysis:  As the most widely used and available form of dialysis used in children, Acute Peritoneal Dialysis supports kidney function by maintaining fluid and electrolyte balance daily for anywhere between eight to 24 hours. This is done by using a patient’s own peritoneal membrane as a filter in association with a PD catheter. This form of dialysis is often used after cardiopulmonary bypass as it provides a safe and temporary dialysis option.
• Continuous Renal Replacement Therapy (CRRT): Commonly used in the Pediatric Intensive Care Units, CRRT is a continuous form of dialysis that supports kidney function by maintaining a fluid and electrolyte balance 24/7. CRRT is reserved for the sickest patients with acute kidney injury as it supports the chance of regaining kidney function and renal function recovery.
• Aquapheresis or Ultrafiltration: A medical therapy that supports kidney function by removing excess fluid from the patient in a slow manner that helps restore a patient’s fluid balance. Fluid removal using the Aquapheresis technique is done gradually and has no significant impact on a patient’s blood pressure, heart rate of electrolytes. This procedure is usually performed for four to six hours on patients who are fluid overloaded due to surgical procedures, heart failure or kidney disease.

Acute Therapeutic Pheresis

Pheresis is a therapy that is used to remove antibodies pathogenic proteins or unwanted cellular components from a patient. It is commonly used for patients who may be experiencing acute rejection of a transplanted organ, some neurological issues and those patients with extremely elevated white cell counts or elevated sickle hemoglobin cells.

• Acute Therapeutic Plasma Exchange (Plasmapheresis): A therapy used to remove circulating pathogenic proteins or antibodies which are elevated due to a response to an autoimmune disease. These antibodies and proteins are found in the blood, more specifically, the plasma. Plasmapheresis provides a way to remove plasma and discard the unwanted antibodies and proteins.
• Acute and Chronic Red Blood Cell Exchange (Erythrocytapheresis): Removes abnormal red cells from a patient that are causing symptoms, such as stroke, iron overload, or organ dysfunction. Commonly used for sickle cell patients in acute sickling crisis, or used as preventive maintenance to avoid complications of the disease.
• Acute White Blood Cell Depletion (Leukapheresis): This therapy removes white blood cells from a patient with newly diagnosed or relapsing leukemia. By removing the high level of white blood cells from the blood, the chemotherapy therapy used to treat the leukemia can be more effective.
• LDL Apheresis (Liposorber): This therapy removes LDL cholesterol from a patient’s blood plasma, as is often seen in refractory focal segmental glomerular sclerosis (FSGS).  

Acute Extracorporeal Liver Support

Cincinnati Children’s is excited to be one of the few sites worldwide that is able to offer acute extracorporeal liver support, or Molecular Adsorbent Recirculating System (MARS) therapy, for those patients that have hepatic encephalopathy or for the treatment of drug overdose and poisoning. MARS provides efficient removal of exogenous and endogenous hepatic toxins in patients with acute liver failure. This therapy supports the patient with acute liver failure, providing a chance to recover native liver function.

Acute Extracorporeal Immunomodulation

Cincinnati Children’s is excited to the first site worldwide to offer acute extracorporeal immunomodulation with the selective cytopheretic device (SCD: Quelimmune™) as part of its clinical program for patients with acute kidney injury with sepsis or a sepsis like syndrome receiving CRRT as part of standard of care. The SCD attracts activated neutrophils and monocytes in a continuous cell processing system, and converts them to less inflammatory more reparative phenotypes. The CACN led the two studies in the US the served as the clinical data for the SCD to receive clearance from the FDA under a Humanitarian Device Exemption.