Health Care Science and Innovation

Aquadex Ultrafiltration Device Provides New Hemodialysis Option for Neonates Experiencing Renal Failure

Earlier this year, AdventHealth for Children’s Neonatal Intensive Care Unit (NICU) became the first in Central Florida to provide dialysis treatment using the Aquadex Smartflow® System on neonates experiencing renal failure. The hospital remains the only facility in Central Florida to offer this technology and has successfully performed 19 neonatal Aquadex treatments since January 2023.


Acute kidney injury or renal failure commonly occurs in critically ill neonates and is associated with increased morbidity and mortality. It can develop from congenital kidney anomalies, occur secondary to infections or arise due to drug toxicities. While continuous renal replacement therapy (CCRT) and standard hemodialysis is a method of providing kidney support to older children, it carries a higher risk of complications and worse overall outcomes for neonates. Peritoneal dialysis (PD) is the standard treatment option for neonates. However, it cannot be performed on infants with certain abdominal diseases or defects or on those who have had recent abdominal surgeries.

Approved by the U.S. Food and Drug Administration (FDA) for isolated ultrafiltration in adults with diuretic-resistant congestive heart failure, the Aquadex machine has an extra corporeal circuit volume (ECV) of 33ml that is smaller than standard CCRT machines (100ml) and functions by filtering the blood and removing fluids from the patient slowly over a period of several hours. A multi-center, retrospective study found that the Aquadex may mitigate some of the complications seen with other treatment modalities, providing a potential new kidney replacement therapy (KRT) option for neonates with end-stage kidney disease (ESKD) who are unable to initiate PD.

“Over the past four years, pediatric nephrologists have adapted the Aquadex machine and modified its use for neonates and children, allowing small volumes to be removed safely, particularly in very sick neonates,” explains AdventHealth for Children Pediatric Nephrology Medical Director Deogracias Peña, MD. “With further modifications, the Aquadex is now used to perform hemofiltration, which is similar to what a regular dialysis machine or CRRT machine can do.”

Aquadex Team Photo

AdventHealth for Children NICU Medical Director Narendra Dereddy, MD, explains that the Aquadex machine can also help to transition neonates to long-term PD.

“It is ideal to wait a few days after PD catheter placement before performing PD,” he shares. “In addition, PD is not as reliable in removing excess fluid and waste compared to hemodialysis, and the process is slow. With its smaller ECV, the Aquadex machine has made it safer for us to perform dialysis in our neonates. While it won’t replace other treatment modalities, the Aquadex provides us a valuable new tool to manage neonate renal failure and improve patient survival by allowing time for the kidneys to recover or for transition to long-term PD.”

For the 4th time, AdventHealth for Children is recognized by U.S. News & World Report as the best children’s hospital for newborn care in Florida.

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