Renal replacement therapies in neonates: issues and ethics

Area of Science:

• Nephrology
• Neonatalogy
• Pediatric Urology

Background:

• Chronic irreversible kidney disease (CIKD) requiring dialysis is a rare neonatal condition.
• Often diagnosed antenatally via ultrasound, associated with congenital abnormalities of the kidneys and urinary tract (CAKUT).
• Increased incidence of prematurity and being small for gestational age (SGA) in affected neonates.

Purpose of the Study:

• To discuss the diagnosis, management, and outcomes of neonates with CIKD.
• To explore strategies for managing renal function and fluid/electrolytes in this population.
• To address the complex ethical considerations in managing neonates with end-stage renal disease.

Main Methods:

• Review of cases diagnosed with CIKD in the neonatal period.
• Analysis of antenatal ultrasound findings and associated CAKUT.
• Evaluation of management strategies including fluid and electrolyte balance.
• Assessment of comorbidity impact on survival for neonates on dialysis.

Main Results:

• Neonates with CIKD often present with CAKUT, prematurity, and SGA status.
• Careful management can potentially delay the need for dialysis by optimizing renal function.
• High incidence of comorbidity significantly affects survival rates.
• Survival for neonates on dialysis is approximately 80% at five years.

Conclusions:

• CIKD in neonates is a complex condition requiring multidisciplinary management.
• Delayed dialysis through conservative management is a viable strategy for some.
• Comorbidities are critical determinants of survival in this vulnerable population.
• Ethical issues are paramount in the care of neonates with end-stage renal disease.