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Acute kidney injury and peritoneal dialysis in extremely low birth weight newborns
Huseyin Kaya1, İsmail K Gokce2, Hatice Turgut2
1Inonu University School of Medicine, Division of Neonatology, Department of Pediatrics, Turgut Ozal Medical Center, Malatya, Türkiye - doctor_ctf@hotmail.com.
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Peritoneal dialysis (PD) effectively treats acute kidney injury (AKI) in extremely low birth weight (ELBW) infants. This renal replacement therapy rapidly corrects biochemical imbalances and initiates diuresis in ELBW infants with kidney failure.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Critical Care
Background:
- Acute kidney injury (AKI) affects a significant portion of extremely low birth weight (ELBW) infants in neonatal units, sometimes necessitating renal replacement therapy.
- Indications for renal replacement therapy in ELBW infants include hyperkalemia, hypovolemia, and resistant acidosis.
Purpose of the Study:
- To evaluate the efficacy and outcomes of peritoneal dialysis (PD) as a renal replacement therapy for acute kidney injury (AKI) in extremely low birth weight (ELBW) infants.
Main Methods:
- A retrospective assessment of ELBW infants admitted between January 2015 and December 2017, who survived beyond 48 hours.
- Patients were monitored for the development of AKI and the subsequent need for and outcomes of peritoneal dialysis (PD).
Main Results:
- AKI developed in 25 out of 201 ELBW infants, with nine requiring PD.
- PD, initiated for medically refractory hyperkalemia, resulted in successful recovery in six infants, with biochemical normalization within three days and diuresis starting shortly after.
- Complications included dialysis leakage and hyperglycemia in two patients each; three infants died during PD treatment.
Conclusions:
- Peritoneal dialysis (PD) is a viable and often the only accessible renal replacement therapy option for ELBW infants with renal failure in many neonatal units.
- PD demonstrates rapid correction of biochemical abnormalities and prompt initiation of diuresis in ELBW infants, attributed to their larger peritoneal surface area relative to body weight.
Background:
In 12.5-56% of extremely low birth weight (ELBW) infants treated in newborn units, acute kidney injury (AKI) develops. Some of these infants may need renal replacement therapy for several reasons including hyperkalemia, hypovolemia and resistant acidosis.
Methods:
All ELBW infants who were followed in our hospital between January 2015 and December 2017 and who lived longer than 48 hours were assessed. Patients were followed for AKI and peritoneal dialysis (PD).
Results:
AKI developed in 25 of 201 ELBW infants. PD was administered to nine patients. PD was initiated at a median of 11 days (2-22 days) for all patients due to hyperkalemia which did not respond to medical treatment. Three of the nine infants who received PD died while dialysis was ongoing. The remaining six patients completed PD successfully. In these patients, the serum potassium value returned to normal in three days, and dialysis was continued for a median of 93 hours (40-172 hours). Dialysis leakage occurred in two patients, and hyperglycemia developed in two patients. On average, diuresis started at the 25th hour (8-40th hour).
Conclusions:
In the renal failure treatment of ELBW infants, PD is the only option which can be used for many units. It was found that in ELBW infants, who had wider peritoneal surface when compared to their body weight, biochemical values recovered rapidly with PD, and diuresis started a short while later in most patients.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...