Fragile Flow: The Burden of Hypotension in Neonates on Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM™)

Introduction: Infants and children with acute kidney injury requiring dialysis (AKI-D) historically used modified adult filters. The Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM™) was designed for children 2.5–10 kg. Hypotension is a known adverse event in pediatric continuous kidney replacement therapy (CKRT), but its incidence on CARPEDIEM™ remains unknown. We aimed to assess the incidence and duration of hypotension in children receiving CKRT via CARPEDIEM™ compared to matched controls Methods: We conducted a single-center retrospective case-control study of neonates and infants <10 kg receiving CKRT via CARPEDIEM™. Cases were matched by postmenstrual age (PMA), sex, vasoactive/inotropic use, mechanical ventilation, and delivery mode. Mean arterial pressure (MAP) was analyzed at 1-minute intervals over the first 5 days of therapy. Our primary outcome was hypotension defined as MAP <3rd percentile for PMA lasting ≥2 minutes. Results: We included 34 patients (17 CARPEDIEM™, 17 controls). Median PMA at data collection was 38.8 weeks (37.9–39.85); 53% were male. All controls had daily hypotension, whereas the highest incidence in CARPEDIEM™ cases was on day 5 (82%). Total hypotension duration [2549 min (1500–3210) vs. 152 min (34–820), p <0.01] and episode duration [204 min (153–271) vs. 49 min (9–110), p <0.01] were significantly lower in the CARPEDIEM™ group. Conclusion: Patients receiving CKRT via CARPEDIEM™ had lower incidence of hypotension incidence, though 82% still experienced hypotension over our 5-day observation period. Future studies should explore risk factors associated with the development of hypotension on CARPEDIEM™.