The Selective Cytopheretic Device (SCD) for Acute Kidney Injury (AKI) and Hepatorenal Syndrome (HRS) Type I

Inclusion Criteria: * Cirrhosis with ascites. * Not currently listed for liver transplant. * Worsening renal failure most likely due to Hepatorenal Syndrome Type I with low glomerular filtration rate (GFR). * No sustained improvement in renal function after diuretic withdrawal and expansion of plasma volume with 1.5 liters of plasma expander. * No sustained improvement in renal function or intolerant to treatment with octreotide and /or midodrine. * Able to tolerate regional citrate anticoagulation and continuous renal replacement therapy (CRRT) for 24 hours or greater. * Intent to deliver full supportive care through aggressive management utilizing all available therapies for a minimum of 96 hours. * Receiving medical care in an intensive care unit. * Absence of shock, ongoing bacterial infection and fluid losses, and current treatment with nephrotoxic medications, hepatocellular carcinoma. * Females of child bearing potential who are not pregnant (confirmed by a negative serum pregnancy test) and not lactating if recently post-partum. * Two (2) consecutive intra-circuit Ionized Calcium (iCa) levels \<0.40 Millimoles per liter (mmol/L), at least 30 minutes apart. Exclusion Criteria: * Evidence of chronic kidney disease Stage 4. * Patients with Model for End-Stage Liver Disease (MELD) score \> 40 (since these patients are unlikely to survive a 90-day follow-up period). * Acute or chronic use of circulatory support device. * Mechanical ventilation for greater than 7 consecu…