Hemodiafiltration in infants with complications during peritoneal dialysis

Area of Science:

• Pediatric Nephrology
• Renal Replacement Therapy

Background:

• Neonatal end-stage renal disease (ESRD) presents significant mortality risks, especially within the first year of life.
• Established renal replacement therapies for neonates are limited, necessitating innovative treatment strategies.

Observation:

• A combination therapy of peritoneal dialysis (PD) and intermittent hemodiafiltration (iHDF) was administered to four neonates (under 28 days old) with ESRD.
• Patients received iHDF initially, transitioned to PD, and were switched back to iHDF during PD complications, including ultrafiltration failure, peritoneal leaks, and refractory peritonitis.
• iHDF served as a temporary measure (bridge therapy) five times, particularly during abdominal surgeries, facilitating PD initiation or resumption.

Findings:

• All four neonates survived their first year of life with the combined PD and iHDF treatment.
• Two patients underwent successful kidney transplantation at 22 and 35 months of age.
• The remaining two patients continue on renal replacement therapy, one on PD and the other on iHDF, at 28 and 25 months, respectively.

Implications:

• The combination of PD and iHDF demonstrates a promising strategy for managing neonatal ESRD, enhancing survival rates.
• Intermittent hemodiafiltration (iHDF) can serve as an effective bridge therapy, stabilizing patients during PD-related complications and enabling long-term management until kidney transplantation.
• This approach may improve outcomes for neonates with ESRD, offering a pathway to transplantation and long-term survival.