Renal Replacement Therapy in Neonates

Spector, Benjamin L.; Misurac, Jason

doi:10.1542/neo.20-12-e697

Cited by 21 publications

(22 citation statements)

References 78 publications

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“…This circuit has the advantages of small size (allowing portability) with accurate blood pump flow rates and minimal priming volumes with flow errors of less than or equal to 7.5% [5]. The Nidus machine is targeted for application in the neonate; however, it can be used even in very low birth weight/extremely low birth weight infants with a weight range of 800 g to 8 kg [5]. Although the number of uses related to these devices is low, it is stated that there are fewer complications.…”

Section: Discussionmentioning

confidence: 99%

“…Eight (72.7%) patients in the CVVHDF group and 3 (60%) in the PD group received mechanical ventilation support. To address the difficulties in administering CRRT in neonates, lower extracorporeal volume CRRT circuits have been developed, such as the Cardiac and Renal Pediatric Dialysis Emergency (CARPEDIEM) circuit and the Newcastle infant dialysis ultrafiltration system (Nidus) [5]. CARPEDIEM was developed for small and premature infants with low weight and estimated blood volumes ranging from 200 to 1000 mL [5].…”

Section: Discussionmentioning

confidence: 99%

“…Among these, CVVHDF and PD are the most commonly used methods [1][2][3][4]. Although IHD is the most efficient mode of dialysis, multiple challenges exist in providing HD to the neonate thereby limiting its use relative to PD and CRRT in neonatal populations [5].…”

Section: Introductionmentioning

confidence: 99%

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Continuous veno‐venous hemodiafiltration in neonates with maple syrup urine disease

et al. 2022

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Introduction Herein, we aimed to discuss our experience in 16 newborn patients with Maple syrup urine disease (MSUD) who were treated with urgent renal replacement therapy (RRT). Methods The patients underwent continuous veno‐venous hemodiafiltration (CVVHDF) or peritoneal dialysis (PD) as renal replacement therapy. Results Eleven (68.75%) patients underwent CVVHDF and five (31.25%) underwent peritoneal dialysis. The median leucine reduction rate per hour was 2.56% (1.75–7.6) in the CVVHDF group, 0.78% (0.54–1.83) in the PD group, and was significantly higher in the CVVHDF group (p = 0.001). Posttreatment plasma leucine levels were found to be 198 (20–721) μmol/L in the CVVHDF group and 600 (250–967) μmol/L in the PD group, and CVVHDF was found to be significantly lower (p = 0.08). Complications such as hypotension, electrolyte imbalance, and filter obstruction occurred in the CVVHDF group. Conclusion This study showed that CVVHDF is more effective than PD for rapidly eliminating elevated leucine levels caused by MSUD in the newborn and it is not associated with increased complication rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Continuous veno‐venous hemodiafiltration in neonates with maple syrup urine disease

et al. 2022

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“…Despite consistent improvement in care of critically ill neonates, acute kidney injury (AKI) still has an incidence rate of 6-8% in neonatal intensive care units (NICUs), especially in low-birth-weight infants (LBWIs), including very LBWI (VLBWIs), and extremely LBWI (ELBWIs) (1)(2)(3). Neonates with AKI have a mortality rate of 45%, and renal failure accounts for 7% of all deaths in NICUs (4,5).…”

Section: Introductionmentioning

confidence: 99%

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

Xing¹,

Sheng²,

Liu³

et al. 2021

Transl Pediatr

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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.

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“…As the use of continuous renal replacement therapy (CRRT) in the critically ill population for the management of kidney dysfunction has increased over recent decades, so has its use in neonates and children. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] The reasons for this increase likely stem from the growing data, nomenclature consensus, and clinically meanginful outcomes refinement. In pediatrics, the last decade has seen increasing number of studies, and educational programs to improve the provider's ability to provide safe and effective CRRT, here onwards, referred to as kidney support therapy (KST) for acute kidney injury (AKI).…”

mentioning

confidence: 99%

Kidney support therapy in the pediatric patient: Unique considerations for a unique population

Askenazi

Basu

2021

Seminars in Dialysis

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The use of kidney support therapy (KST) for use in managing patients with acute kidney injury (AKI) has expanded greatly in the last several decades. The growing use of KST modalities in children, and now in neonates, has been associated with opportunities for education, clinical research, clinical practice improvements, and outcomes research. A multitude of controversies exist in the field of pediatric KST-many of which are shared by adult critical care nephrology practice. Simultaneously, pediatric KST has led the way to a burgeoning exploration of the importance of fluid overload as it relates to KST initiation and management and also with quality improvement. In this review, we will explore and describe the paradigms contained with pediatric KST used to support children with AKI. In addition to the governing principles related to the mechanics of KST, we will describe the novel aspects of newer support machines and ethical considerations of KST provision. Anticoagulation, dose, and modality will be discussed as well as priming procedures for special considerations. The utilization of KST across pediatric populations represents the next frontier of critical care nephrology.

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Renal Replacement Therapy in Neonates

Cited by 21 publications

References 78 publications

Continuous veno‐venous hemodiafiltration in neonates with maple syrup urine disease

Continuous veno‐venous hemodiafiltration in neonates with maple syrup urine disease

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

Kidney support therapy in the pediatric patient: Unique considerations for a unique population

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