A Multi-Center, Pilot Study to Assess the Safety and Efficacy of a Selective Cytopheretic Device (SCD) for the Treatment of Immunomodulatory Dysregulation Due to Pediatric Acute Kidney Injury (AKI)
试验速览
- 阶段
- 不适用
- 状态
- 终止
- 入组人数
- 7
- 试验地点
- 4
- 主要终点
- Number of SCD-related Adverse Events (AE)
研究概览
简要总结
The SCD PED-02 trial is examining the safety and efficacy of the Selective Cytopheretic Device (SCD) in treating pediatric acute kidney injury (AKI). AKI promotes a systemic inflammatory response syndrome (SIRS) which results in systemic microvascular damage and, if severe, multi-organ dysfunction. Activated circulating leukocytes play a central role in this process. The SCD is a synthetic membrane with the ability to bind activated leukocytes and, when used in a continuous renal replacement therapy (CRRT) extracorporeal circuit in the presence of regional citrate anticoagulation, modulates inflammation. The SCD PED-02 study will test the primary hypothesis that up to ten sequential 24-hour SCD treatments in pediatric patients with AKI will be completed safely and improve survival compared to historical controls who received CRRT alone.
详细描述
The SCD PED-02 trial is examining the safety and efficacy of the Selective Cytopheretic Device (SCD) in treating pediatric acute kidney injury (AKI). Importantly, acute kidney injury is a highly lethal condition in critically ill patients. Despite improvements in acute medical care and advances in dialysis therapies, the mortality rate during the past four decades of this condition has not improved. Critically ill patients with AKI in hospital ICU settings have mortality rates of approximately 50%, including pediatric patients. AKI promotes a systemic inflammatory response syndrome (SIRS) which results in systemic microvascular damage and, if severe, multi-organ dysfunction. Activated circulating leukocytes play a central role in this process. Leukocytes, especially neutrophils, are major contributors to the pathogenesis and progression of many inflammatory disorders, including SIRS, sepsis, ischemia reperfusion injury, and acute respiratory distress syndrome (ARDS). Many therapeutic approaches are under investigation to limit the activation and tissue accumulation of leukocytes at sites of inflammation to minimize tissue destruction and disease progression.
The SCD is comprised of tubing, connectors, and a synthetic membrane cartridge. The device is connected in series to a commercially available Continuous Renal Replacement Therapy (CRRT) device. Blood from the CRRT circuit is diverted after the CRRT hemofilter through to the extra capillary space (ECS) of the SCD. Blood circulates through this space and it is returned to the patient via the venous return line of the CRRT circuit. Regional citrate anticoagulation is used for the entire CRRT and SCD blood circuits. The SCD is a synthetic membrane with the ability to bind activated leukocytes and, when used in a continuous renal replacement therapy (CRRT) extracorporeal circuit in the presence of regional citrate anticoagulation, modulates inflammation.
The SCD PED-02 study will test the primary hypothesis that up to ten sequential 24-hour SCD treatments in pediatric patients with AKI will be completed safely and improve survival compared to historical controls who received CRRT alone.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- — 至 17 Years（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •The patient's parent or legal representative has provided informed consent
- •Must be receiving medical care in an intensive care unit
- •Age less than 18 years.
- •Body weight between ≥10 and ≤ 20 kilograms
- •Intent to receive full supportive care through aggressive management
- •Clinical diagnosis of AKI requiring CRRT
- •At least one non-renal organ failure OR presence of proven/suspected sepsis
排除标准
- •Threshold blood pressure of 80/40 mmHg
- •Patients with a solid organ transplant or those with a bone marrow or stem cell transplant in the previous 100 days or who have not engrafted
- •Acute or chronic use of circulatory support device, other than extracorporeal membrane oxygenation (ECMO)
- •Presence of preexisting advanced chronic renal failure on chronic renal replacement therapy or with an estimated glomerular filtration rate less than 30 mL/min/1.73m2
- •AKI occurring in the setting of burns, obstructive uropathy, scleroderma renal crisis, atheroembolism, functional or surgical nephrectomy, cyclosporine or tacrolimus nephrotoxicity
- •Metastatic malignancy which is actively being treated or may be treated by chemotherapy or radiation during the subsequent three month period after study therapy
- •Chronic immunosuppression with the exception of corticosteroids up to a dose of 10 mg of prednisone per day
- •Known positive HIV or AIDS or COVID-19
- •Current Do not Attempt Resuscitation (DNAR), Allow Natural Death (AND), or withdrawal of care status, or anticipated change in status within the next 7 days
- •Patient not expected to survive 28 days because of an irreversible medical condition
- •Any medical condition that the Investigator thinks may interfere with the study objectives
- •Treating clinician does not feel it is in the best interest of the patient
- •Platelet count <15,000/mm3
- •Concurrent enrollment in another interventional clinical trial
- •Use of any other investigational drug or device within the previous 30 days
- •Use of AN-69 hemofilter membrane for CRRT
结局指标
主要结局
Number of SCD-related Adverse Events (AE)
时间窗: From enrollment to Day 60 post treatment
Total number of AEs across all participants that are considered to be at least possibly related to SCD therapy per the site investigator
Number of Unanticipated Adverse Device Effects (UADE)
时间窗: From enrollment to Day 60 post treatment
Total number of UADEs across all participants treated with the SCD
次要结局
- Hospital Length of Stay(From enrollment to Day 60 post treatment)
- Mortality(Day 60 post treatment)
- Renal Recovery(Day 60 post treatment)
- Intensive Care Unit (ICU) Length of Stay(From enrollment to Day 60 post treatment)
研究者
Stuart Goldstein, MD
Director, Center for Acute Care Nephrology
Children's Hospital Medical Center, Cincinnati