Efficacy Study of a Selective Cytopheretic Device (SCD) in Patients With Acute Kidney Injury

Acute kidney injury 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.

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).

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.

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 Kidney Injury 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. Presence of at least one non-renal organ failure or present sepsis as defined in
Appendix C.

9. All patients must be able to tolerate regional citrate anticoagulation.

Exclusion Criteria:

1. Irreversible brain damage based on available historical and clinical information.

2. Presence of any organ transplant at any time.

3. Acute or chronic use of circulatory support device such as LVADs, RVADs, BIVADs, ECMO.

4. Presence of preexisting advanced chronic renal failure (i.e., ESRD) requiring chronic
renal replacement therapy prior to this episode of acute kidney injury.

5. AKI 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.

6. Metastatic malignancy which is actively being treated or may be treated by
chemotherapy or radiation during the subsequent three month period after study
therapy.

7. Chronic immunosuppression (e.g., HIV/AIDS, chronic glucocorticoid therapy >20 mg/day
prednisone equivalent on a chronic basis). The acute use of glucocorticoids is
permissible.

8. Severe liver failure as documented by a Child-Pugh Liver Failure Score >12 (see
Appendix F).

9. Currently in Do Not Resuscitate (DNR) status or DNR status anticipated within the next
7 days.

10. Currently in Comfort measures Only or Comfort Measures Only status anticipated within
next 7 days.

11. Patient is moribund or chronically debilitated for whom full supportive care is not
indicated.

12. Patient not expected to survive 28 days because of an irreversible medical condition.
(This is not restrictive to AKI, and may include situations such as the presence of
irreversible brain damage, untreatable malignancy, inoperable life threatening
condition, or any condition to which therapy is regarded as futile by the PI.)

13. Any medical condition that the Investigator thinks may interfere with the study
objectives.

14. Physician refusal.

15. Patient is a prisoner.

16. Dry weight of >150 kg.

17. More than one hemodialysis treatment during this hospital admission or prior to
transfer from an outside hospital.

18. Platelet count <30,000/mm3 at time of screening.

19. Concurrent enrollment in another interventional clinical trial. Patients enrolled in
clinical trials where only measurements and/or samples are taken (NO TEST DEVICE OR
TEST DRUG USED) are allowed to participate.

20. Use of any other Investigational drug or device within the previous 30 days.