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Neonatal extracorporeal renal replacement therapy-a routine renal support modality?
Leyat Tal1, Joseph R Angelo1, Ayse Akcan-Arikan2,3
1Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Pediatric Nephrology (Berlin, Germany)
|June 9, 2016
Summary
Peritoneal dialysis (PD) is preferred for neonatal acute kidney injury (AKI), but not always feasible. Continuous renal replacement therapy (CRRT) faces challenges in neonates, highlighting a need for specialized devices.
Area of Science:
- Neonatal medicine
- Pediatric nephrology
- Renal replacement therapy
Background:
- Peritoneal dialysis (PD) is the primary extracorporeal therapy for neonatal acute kidney injury (AKI).
- PD is contraindicated in neonates with prior abdominal surgery, hyperammonemia, or significant fluid overload.
- Early PD initiation post-catheter placement increases risks of leakage and infection.
Discussion:
- Continuous renal replacement therapy (CRRT) presents significant challenges in neonates, including the need for large central venous access and adapted equipment.
- CRRT machines designed for older patients lack precise ultrafiltration capabilities for neonates.
- Modifications to existing CRRT practices are possible but highlight the need for neonate-specific devices.
Key Insights:
- Neither PD nor adapted CRRT are ideal for all neonates with AKI.
- Current extracorporeal therapies require careful consideration of patient-specific factors and potential complications.
- There is a critical gap in specialized CRRT technology for the neonatal population.
Outlook:
- Development of CRRT devices specifically designed for neonates is essential.
- Sharing clinical experiences within the pediatric nephrology community is crucial for optimizing care in the interim.
- Improved extracorporeal therapies will enhance outcomes for neonates with AKI.
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