Pos-032 Barrier to and Constraints of Acute Peritoneal Dialysis in Acute Kidney Injury: A National Survey

Abstract

setting where a proportion of neonates do not receive TH, we conducted this study with the following objectives a) to compare the incidence and severity of AKI in neonates with perinatal asphyxia who receive therapeutic hypothermia (TH+) to those who don't receive it (TH-) b) compare the levels of urinary biomarkers in those with AKI to those without AKI. Methods: A prospective observational study was conducted in the neonatal intensive care of a tertiary referral hospital from March 2018 to November 2019. Neonates (inborn and outborn) >35 completed weeks gestational age with perinatal asphyxia and moderate to severe hypoxic ischemic encephalopathy using the Sarnat and Sarnat classification were included. TH using whole body cooling was administered in all babies who were admitted within 6 hours of life for 72 hours with 18 hours of re-warming. The incidence and severity of AKI was compared between TH+ and TH-. Urinary biomarkers like neutrophil gelatinase associated lipocalin (NGAL), cystatin C (ucysC) and beta 2 microglobulin (B2m) were tested on day 1 of life using a Luminex based assay and were compared between those who had and did not have AKI.Results: Among 39 neonates, 29 (74%) received therapeutic hypothermia. Thirty (76%) were males and 25 (64%) were inborn babies, 10 (25%) were preterm. The median birth weight was 2.3 (2.1, 2.7) kg. The incidence of AKI was 5/10 (50%) in TH-group when compared to 5/29 (18%) in TH+ group (p=0.04). In the TH+ group, 80% had stage 1 AKI, 20% had stage 2 AKI when compared to 20% stage 1, 60% stage 2 AKI and 20% stage 3 in TH-group (p=0.15). None of neonates required dialysis. After adjusting for other risk factors for AKI like shock, ventilation and sepsis, TH+ was associated with a significantly lower incidence of AKI (p=0.03). The urinary levels of NGAL were higher in neonates with AKI (210 (66, 473) ng/ml) when compared to those without AKI (140 (42, 556) ng/ml) (p=0.65) while levels were comparable for B2m (p=0.11) and ucysC (p=0.45) . Conclusions: Therapeutic hypothermia is associated with a significantly lower incidence of AKI in neonates with perinatal asphyxia. Urinary NGAL is a useful biomarker for the diagnosis of AKI in neonates with perinatal asphyxia.