Clinical Experience and Future Challenges in CKRT Implementation for Acute Kidney Injury Following Neonatal Asphyxia

Abstract

Summary: Blood purification therapy in neonates and infants poses unique challenges owing to the large proportion of blood volume required for extracorporeal circulation, the risk of circuit clotting at a low blood flow rate, and difficulties in maintaining body temperature. In the present case, continuous kidney replacement therapy (CKRT) using the ACH-Σ^® device was performed on a 4-day-old male neonate with acute kidney injury following neonatal asphyxia. By using the neonatal and pediatric blood purification therapy condition sheet and blood priming manual, stable extracorporeal circulation was achieved. In addition, appropriate blood priming, electrolyte correction, and body temperature management using a blood warmer ensured maintain hemodynamic. Circuit clotting caused by a low blood flow rate was mitigated by monitoring the activated clotting time and the distribution of anticoagulants. However, challenges, such as the risk of hemorrhage due to thrombocytopenia, catheter-related embolism, and infection, remain. This report provides practical insights into the implementation of CKRT, with the aim of contributing to the standardization of neonatal blood purification therapy and the improvement of treatment outcomes. Furthermore, safety measures from the perspective of clinical engineers were evaluated to enhance the quality and safety of treatment.