Carpediem™ Dialysis for the Smallest of Patients

Children’s Hospital Colorado is proud to introduce a groundbreaking advancement in caring for infants facing kidney failure: the Cardio-Renal Pediatric Dialysis Emergency Machine, or Carpediem™. This first-of-its-kind dialysis technology marks a significant leap forward in pediatric nephrology and neonatal care, offering continuous renal replacement therapy (CRRT) for the smallest and most fragile of patients with kidney anomalies during all phases of perinatal care. In addition, it can be a promising treatment option for infants whose kidneys are severely injured due to sepsis or decreased renal blood flow. Acquiring this technology expands our capabilities as a pediatric center with the diversification of equipment and therapy types to offer the full gamut of dialysis treatment.

A game-changer for inpatient neonatal dialysis care

Our specialized inpatient dialysis program provides unparalleled care for our most critical patients, including infants and neonates with renal agenesis, kidney dysplasia and hypoplasia, bladder outlet obstruction disorder and others. The Carpediem™ device has further enhanced our ability to provide CRRT in critical care settings for neonates and infants.

Approved by the FDA in 2020, Carpediem™ is designed for neonates weighing between 5.5 and 22 pounds. Our team, recognizing the potential for broader application, is prepared to extend Carpediem™ to smaller infants on a case-by-case basis, provided suitable catheter placement can be achieved. Before Carpediem™, options for such young patients were limited, with existing devices primarily designed for adults and intended for those weighing at least 44 pounds. Introducing Carpediem™ in our hospital is a game-changer, offering hope and potentially life-saving treatment to those who previously had few or no alternatives.

Expanded capabilities with safety in mind

As the only center in the region and one of only several in the nation to offer such capabilities, the introduction of Carpediem™ allows us to support smaller patients more effectively. It addresses the complexities of managing smaller patients with a machine that requires smaller blood volumes that can operate effectively at lower blood flow rates and accommodates smaller catheters — essential for treating neonates. Our team's experience in training with and implementing Carpediem™ has been positive, highlighting its potential to significantly improve our treatment outcomes.

Carpediem™ enhances the capability to provide safe and effective renal replacement therapy for neonates, with its design allowing for more exact prescription and operation through smaller hemodialysis lines. We also participate in the Improving Carpe Diem Outcomes in Neonates through Collaboration (ICONIC Collaborative), a national research organization that develops a database to track experiences and outcomes, demonstrating our commitment to collaborative, research-intensive care.

Impact on prenatal care and delivery planning

Carpediem™ also significantly impacts prenatal care and delivery planning. Many babies with a variety of renal anomalies are diagnosed prenatally and referred to the Colorado Fetal Care Center for fetal ultrasound surveillance to optimize renal and pulmonary function with fetal interventions and for prenatal multidisciplinary planning in preparation for birth and neonatal management. Upon diagnosis, all fetal and pediatric specialists come together in one room, on one day, to review all imaging (fetal ultrasound, MRI and echocardiography) and various testing options, confirm the diagnosis and review potential prenatal and postnatal treatment options with families.

Many patients are at risk for oligohydramnios (low amniotic fluid around the fetus) or worse, anhydramnios (no fluid around the fetus), which can significantly hinder fetal development, especially the lungs. If there is a urinary tract obstruction, a small tube can be placed in utero to shunt a dilated urinary tract structure into the amniotic space to help restore fluid around the fetus. Amnioinfusion may be beneficial to support these patients for necessary lung development prenatally and the Colorado Fetal Care Center is part of a multicentered trial for amnioinfusion called the RAFT (Renal Anhydramnios Fetal Therapy) trial.

Having Carpediem™ as an additional support after birth can give patients the best chance at the best possible outcome, especially as it allows renal therapy for the smallest of our high-risk babies who are often delivered early. This technology allows us to provide a smoother transition from prenatal to neonatal care, ensuring that families can access all necessary services under one roof.

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