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Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study
Jihyun Noh1, Chae Young Kim2, Euiseok Jung3
1Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
Insights
Peritoneal dialysis (PD) for extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI) showed a high mortality rate. Careful consideration of PD is advised due to immature organ systems in these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Critical Care
Background:
- Peritoneal dialysis (PD) is occasionally used for extremely-low-birth-weight (ELBW) infants experiencing acute kidney injury (AKI).
- ELBW infants present unique challenges due to their immature organ systems.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.
- To assess the efficacy and complications associated with PD in this high-risk population.
Main Methods:
- Retrospective cohort study of ELBW infants with AKI undergoing PD between January 2008 and February 2018.
- Utilized PD catheters (7.5-9.0 Fr) or central venous catheters (4 Fr) for peritoneal access.
- Administered PD solutions (2.5% or 4.25%) starting at 10 mL/kg, escalated to 20-30 mL/kg for 60-120 min/cycle over 24 hours.
Main Results:
- Twelve ELBW infants (mean gestational age 27.2 weeks, birth weight 706.5 g) were treated, with sepsis as the primary indication for PD.
- Average PD duration was 9.4 days; hyperkalemia improved from 6.8 to 5.0 mg/mL.
- The most frequent complication was catheter dysfunction (75% dialysate leakage); mortality rate was 91.7%.
Conclusions:
- The high mortality rate in ELBW infants with AKI treated with PD underscores the challenges posed by immature organ systems.
- Careful consideration of PD is crucial for treatment decisions, including resuscitation strategies, in this vulnerable group.
Background:
Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.
Methods:
In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5-9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20-30 mL/kg for 60-120 min/cycle continuing for 24 h.
Results:
Twelve ELBW infants (seven male and five female infants) were treated, and their mean (±SD) gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. Two patients had severe perinatal asphyxia (5-min Apgar score ≤ 3). The most important indication for starting PD was AKI due to sepsis. The average (±SD) duration of PD was 9.4 (± 7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (± 4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%.
Conclusions:
In this series, the mortality rate of ELBW infants with AKI treated with PD was relatively high because of their incompletely developed organ systems. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI in terms of decisions regarding resuscitation.
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