Continuous hemodialysis therapy for an extremely low‐birthweight infant with hyperammonemia

Kaneko, M; Ogasawara, Kei; Go, Hayato; Imamura, Takashi; Momoi, Nobuo

doi:10.1111/ped.12101

Cited by 12 publications

(13 citation statements)

References 11 publications

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“…37 ). The main limitations of this method in neonates are the risk of rebound hyperammonaemia and the need to obtain vascular access, although such access has been achieved with the use of a peripheral artery and umbilical vein 44 . A 2007 study comparing different forms of KRT in eight infants with hyperammonaemia found that patients receiving intermittent HD showed a 50% reduction in ammonia levels after 1-2 h, whereas patients treated with CVVHD took 2-14 h to show this level of reduction 34 .…”

Section: Box 3 | Recommendations From the Consensus Panel For Pdmentioning

confidence: 99%

Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy

et al. 2020

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Hyperammonaemia in children can lead to grave consequences in the form of cerebral oedema, severe neurological impairment and even death. In infants and children, common causes of hyperammonaemia include urea cycle disorders or organic acidaemias. Few studies have assessed the role of extracorporeal therapies in the management of hyperammonaemia in neonates and children. Moreover, consensus guidelines are lacking for the use of non-kidney replacement therapy (NKRT) and kidney replacement therapies (KRTs, including peritoneal dialysis, continuous KRT, haemodialysis and hybrid therapy) to manage hyperammonaemia in neonates and children. Prompt treatment with KRT and/or NKRT, the choice of which depends on the ammonia concentrations and presenting symptoms of the patient, is crucial. This expert Consensus Statement presents recommendations for the management of hyperammonaemia requiring KRT in paediatric populations. Additional studies are required to strengthen these recommendations.

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Section: Box 3 | Recommendations From the Consensus Panel For Pdmentioning

confidence: 99%

Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy

et al. 2020

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“…CRRT has traditionally been difficult to perform in lowbirth weight infants because of difficulties with access as well as the size of the circuits relative to the infant's blood volume (46). However, both CRRT and intermittent HD have been successfully performed in low-birth weight neonates weighing ,5 kg (47,48). Many publications favor intermittent HD over peritoneal dialysis and CRRT because of the superior clearance with HD, although there is a paucity of outcome studies (49,50).…”

Section: Hyperammonemia In Neonatesmentioning

confidence: 99%

The Role of RRT in Hyperammonemic Patients

Gupta¹,

Fenves

Hootkins

2016

CJASN

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Hyperammonemia is an important cause of cerebral edema in both adults with liver failure and children with inborn errors of metabolism. There are few studies that have analyzed the role of extracorporeal dialysis in reducing blood ammonia levels in the adult population. Furthermore, there are no firm guidelines about when to implement RRT, because many of the conditions that are characterized by hyperammonemia are extremely rare. In this review of existing literature on RRT, we present the body's own mechanisms for clearing ammonia as well as the dialytic properties of ammonia. We review the available literature on the use of continuous venovenous hemofiltration, peritoneal dialysis, and hemodialysis in neonates and adults with conditions characterized by hyperammonemia and discuss some of the controversies that exist over selecting one modality over another.

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“…Although infrequently reported [23], hemodialysis (HD) still may not be the treatment of choice in neonatal overdoses for the following reasons: (1) extracorporeal blood volumes for hemoperfusion are relatively large, in which maintenance of the circulatory dynamics of premature infants is challenging;…”

Section: Discussionmentioning

confidence: 99%

Effect of Peritoneal Dialysis on Extremely Low Birth Weight Infants: A Retrospective Cohort Study

Noh

Kim

Jung³

et al. 2020

Preprint

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Background: Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.Methods: In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 hours.Results: Twelve ELBW infants (seven male and five female infants) were treated, and their mean gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. There were two patients who had severe perinatal asphyxia (5-min Apgar score ≤3). The most important indication for starting PD was AKI due to sepsis. The average duration of PD was 9.4 (±7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (±4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%.Conclusions: The mortality rate of ELBW infants with AKI treated with PD is quite high because their organ system is not completely developed. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI.

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Continuous hemodialysis therapy for an extremely low‐birthweight infant with hyperammonemia

Cited by 12 publications

References 11 publications

Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy

Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy

The Role of RRT in Hyperammonemic Patients

Effect of Peritoneal Dialysis on Extremely Low Birth Weight Infants: A Retrospective Cohort Study

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