Acute Renal Failure
Conditions
Keywords
Acute Renal Failure, Acute tubular necrosis, Continuous Renal Replacement Therapy, Selective cytopheretic device
Brief summary
The purpose of this protocol is to evaluate the safety of a selective cytopheretic device (SCD) in patients that are on continuous renal replacement therapy (CRRT) for acute renal failure (ARF).
Detailed description
Acute renal failure is a condition where the kidneys are not capable of producing adequate urine. Therefore, another way to remove waste from the body is needed to hopefully allow time for the kidneys to heal. One method of removing waste from the body is called Continuous Renal Replacement Therapy (CRRT) or variations of that therapy. This study will evaluate the safety of the device while it is connected to the CRRT tubing for up to 7 days. Patients will be followed up until day 60 following the treatment.
Interventions
DEVICESelective cytopheretic device (SCD)
The selective cytopheretic device (SCD) is comprised of tubing, connectors and a hemofilter 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 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.
Sponsors
Baim Institute for Clinical Research
Medtox
SeaStar Medical
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
1. A patient, or legal representative, has signed a written informed consent form. 2. Must be receiving medical care in an intensive care unit (e.g., ICU, MICU, SICU, CTICU, Trauma, Mixed, other). 3. Age 18 to 80 years. 4. Females of child bearing potential who are not pregnant (confirmed by a negative serum pregnancy test) and not lactating if recently post-partum. 5. Must be receiving and tolerating CRRT therapy for a minimum of 4 hours, but not longer than 24 hours. 6. Expected to remain in the ICU for at least 96 hours after evaluation for enrollment. 7. A clinical diagnosis of ATN due to hemodynamic or toxic etiologies. ATN is defined as acute renal failure occurring in a setting of acute ischemic or nephrotoxic injury with oliguria (average \<20 mL/hr) for \>6-12 hours or: an increase in serum creatinine ≥2 mg/dL (≥1.5 mg/dL in females) over a period of ≤4 days. (Note: Prerenal, hepatorenal, vascular, interstitial, glomerular, and obstructive etiologies are excluded on clinical or other diagnostic grounds.) 8. At least one non-renal organ failure (modified SOFA organ system score \>2), as defined in Appendix A or presence (proven or suspected) of sepsis as defined in Appendix B. 9. All patients must be able to tolerate regional citrate anticoagulation.
Exclusion criteria
1. Contraindications to regional citrate anticoagulation. 2. Irreversible brain damage based on available historical and clinical information. 3. Presence of a renal transplant at any time. 4. Non-candidacy for acute renal replacement therapy. 5. Non-renal organ transplantation within six months of screening date. 6. Presence of preexisting chronic renal failure prior to this episode of ARF. Preexisting chronic renal failure is defined as baseline serum creatinine \>2.5 mg/dL (men), or \>2.0 mg/dL (women). 7. ARF occurring in the setting of burns, obstructive uropathy, allergic interstitial nephritis, acute or rapidly progressive glomerulonephritis, vasculitis, hemolytic-uremic syndrome, thrombotic thrombocytopenic purpura (TTP), malignant hypertension, scleroderma renal crisis, atheroembolism, functional or surgical nephrectomy, hepatorenal syndrome, cyclosporine or tacrolimus nephrotoxicity. 8. Metastatic malignancy which is actively being treated or may be treated by chemotherapy or radiation during the subsequent three month period after study therapy 9. Chronic immunosuppression (e.g., AIDS, chronic glucocorticoid therapy \>20 mg/day prednisone equivalent on a chronic basis, or chemotherapy). The acute use of glucocorticoids is permissible 10. Severe liver failure as documented by a Child-Pugh Liver Failure Score \>12. 11. Do Not Resuscitate (DNR) status. 12. Comfort measures only. 13. Patient is moribund or for whom full supportive care is not indicated. 14. Patient not expected to survive 28 days because of an irreversible medical condition. 15. Any medical condition that the Investigator thinks may interfere with the study objectives. 16. Physician refusal. 17. Patient pregnant. 18. Patient is a prisoner. 19. Pre-morbid weight \>128.5 kg. 20. More than one hemodialysis treatment or longer than 24 hours since starting CRRT. 21. Platelet count \<30,000/mm3. 22. Concurrent enrollment in another interventional clinical trial. Patients enrolled in clinical trials where only measurements and or samples are taken (NO TEST DEVICE OR DRUG USED) are allowed to participate. 23. Use of any other Investigational drug or device within the previous 30 days.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 60 Day Mortality | Day 60 following treatment end | — |
| 60 Day Renal Recovery | Day 60 following treatment end | The criteria used to measure Renal Recovery requires the patient to be dependent free of CRRT and/or chronic dialysis. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SCD Experimental Treatment Arm Selective Cytopheretic Device
Selective cytopheretic device (SCD): The selective cytopheretic device (SCD) is comprised of tubing, connectors and a hemofilter 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 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. | 35 |
| Total | 35 |
Baseline characteristics
| Characteristic | SCD Experimental Treatment Arm |
|---|---|
| Age, Categorical <=18 years | 0 Participants |
| Age, Categorical >=65 years | 13 Participants |
| Age, Categorical Between 18 and 65 years | 22 Participants |
| Age, Continuous | 56.3 years STANDARD_DEVIATION 15 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants |
| Race (NIH/OMB) Black or African American | 8 Participants |
| Race (NIH/OMB) More than one race | 0 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 2 Participants |
| Race (NIH/OMB) White | 25 Participants |
| Region of Enrollment United States | 35 participants |
| Sex: Female, Male Female | 14 Participants |
| Sex: Female, Male Male | 21 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 11 / 35 |
| other Total, other adverse events | 33 / 35 |
| serious Total, serious adverse events | 23 / 35 |
Outcome results
Primary
60 Day Mortality
Time frame: Day 60 following treatment end
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| SCD Experimental Treatment Arm | 60 Day Mortality | 11 Participants |
Primary
60 Day Renal Recovery
The criteria used to measure Renal Recovery requires the patient to be dependent free of CRRT and/or chronic dialysis.
Time frame: Day 60 following treatment end
Population: Renal Recovery in surviving subjects at Day 60
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| SCD Experimental Treatment Arm | 60 Day Renal Recovery | 24 Participants |