Acute peritoneal dialysis is an efficient and reliable alternative therapy in preterm neonates with acute kidney injury

Abstract

Background: This study aimed to assess the underlying causes and outcomes of acute peritoneal dialysis (APD) and the complications of PD procedure in preterm neonates with acute kidney injury (AKI).Methods: A retrospective study of 21 preterm neonates who underwent APD in a neonatal intensive care unit (NICU) in Peking University Third Hospital between 2016 and 2019 was conducted. The demographic, clinical, biochemistry, and PD procedure -related information of the neonates was analyzed.Results: Of the 21 preterm neonates, the average gestational age (GA) was 28.9±2.6 weeks, and the average birth weight was 1,226.7±495.3 g, and included 5 (23.8%) low-birth-weight infants (LBWIs), 7 (33.3%) very LBWIs (VLBWIs), and 9 (42.9%) extremely LBWIs (ELBWIs). The major underlying causes for APD were asphyxia (66.7%, n=14) and twin-twin transfusion syndrome (47.6%, n=10). PD procedure-related complications mainly involved inadequate drainage (n=5, 23.8%) and drainage infections (n=2, 9.5%). The median duration of PD was 3 days (range, 1 hour-20 days). Compared to pre-PD, blood urea nitrogen (BUN) and serum K + levels were significantly decreased post-PD (P<0.05). After PD, edema disappeared in 77.8% (n=14/18) of patients, and 42.9% patients (n=9/21) gained normal urine output. Although 8 of the 21 (38.1%) patients died and 6 (29.6%) abandoned therapy, 7 (33.3%) patients including 1 VLBWI and 3 ELBWI survived.Conclusions: APD is an efficient and reliable alternative route of renal replacement therapy particularly for reducing BUN and K + levels in preterm neonates with AKI. APD is practicable in critically ill preterm neonates, even in LBWIs and ELBWIs.

Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study

“…These findings are consistent with some other studies from developing countries. 8,[17][18][19] These findings reiterate the need for pre-emptive support for this population prior to the development of AKI which can be done by avoiding further fluid overload, avoiding nephrotoxins and intense daily monitoring of kidney function. 19 One prospective study from India also showed that sepsis, shock and mechanically ventilated infants need PD, similar to the present study.…”

“…The median (IQR) duration of stay in NICU was 10 (6-20.3) days and 65 (13.2%) died during NICU stay. AKI neonates with PD as compared to AKI neonates without PD had a significantly lower median (IQR) duration of stay in NICU (7 (4-14) vs. 11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days; p ¼ 0.004), but significantly higher mortality (31 (70.5%) vs. 34 (7.6%); p < 0.001). This discrepancy was likely attributable to initial poor clinical conditions (sepsis with multiple organ dysfunction syndrome (MODS)) rather than acute PDrelated complications.…”

Kết Quả Điều Trị Thẩm Phân Phúc Mạc Cấp Tại Khoa Hồi Sức Sơ Sinh Bệnh Viện Nhi Đồng 2

“…Đặc điểm dân số trẻ sơ sinh tổn thương thận cấp trong báo cáo loạt ca được TPPM của chúng tôi là đủ tháng, cân nặng lúc sinh > 2500 gam. Tác giả Aslihan Kara và cộng sự cũng báo cáo kinh nghiệm 8 năm làm TTPM ở trẻ sơ sinh thì đa số dân số cũng là trẻ đủ tháng, chiếm 53,8 % các trường hợp [5]. Tương tự, tác giả Nilay Hakan và cộng sự cũng ghi nhận trẻ đủ tháng chiếm 70,1% trong nghiên cứu làm TPPM trong 7 năm [4].…”

“…Tương tự, tác giả Nilay Hakan và cộng sự cũng ghi nhận trẻ đủ tháng chiếm 70,1% trong nghiên cứu làm TPPM trong 7 năm [4]. Gần đây, đã có những báo cáo rằng TPPM cũng là phương pháp thay thế thận có hiệu quả ở những trẻ non tháng nhẹ cân [5].…”

TINKER-ing with neonatal acute kidney injury

“…Other studies report mechanical dysfunction, leakage, peritonitis, bleeding, rarely intestinal perforation and a high mortality (30-91%) among ELBW/VLBW neonates. [12][13][14] Novel approaches for safe and effective PD have proved successful in ELBW and VLBW neonates using modified catheter insertion techniques, intravenous cannulas, umbilical vein catheters and multifunctional flexible 8-10F catheters. [15][16][17][18][19] These novel PD systems using the Seldinger technique are costeffective compared to surgical insertion of Tenckhoff catheters.…”