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Kidney replacement therapy in neonates: utilization trends and outcomes
Marwa M Elgendy1, Hasan F Othman2, Mohamed A Mohamed3
1Department of Neonatology, Cleveland Clinic Children's, Cleveland, OH, USA. elgendm@ccf.org.
Pediatric Nephrology (Berlin, Germany)
|July 5, 2022
Summary
Peritoneal dialysis (PD) and continuous kidney replacement therapy (CKRT) are increasingly used for newborns needing kidney replacement therapy (KRT), often due to congenital heart disease or kidney anomalies. Less than 5% of infants with acute kidney injury received KRT.
Area of Science:
- Pediatric Nephrology
- Neonatal Intensive Care
- Healthcare Informatics
Background:
- Kidney replacement therapy (KRT) is critical for neonates with kidney failure.
- Understanding trends in KRT utilization and associated diagnoses is essential for improving neonatal care.
Purpose of the Study:
- To assess the prevalence and clinical characteristics of newborns receiving KRT.
- To analyze trends in KRT modality utilization (peritoneal dialysis, hemodialysis, continuous KRT) from 2000-2017.
Main Methods:
- Utilized the National Inpatient Sample (NIS) dataset (2000-2017).
- Included newborns treated with peritoneal dialysis (PD), hemodialysis (HD), and continuous KRT (CKRT).
- Employed Cochran-Armitage test for trend analysis of KRT prevalence.
Main Results:
- Over 64 million hospitalized newborns were analyzed; 4,281 received KRT.
- Peritoneal dialysis (PD) was the most common KRT (58.4%), followed by hemodialysis (HD) (23.3%) and continuous KRT (CKRT) (18.3%).
- Major associated diagnoses included congenital kidney anomalies, urinary tract anomalies, and congenital heart disease (CHD). CKRT had the highest hospitalization cost.
- Trends showed increased utilization of PD and CKRT, while HD utilization decreased. Only 4.9% of neonates with acute kidney injury (AKI) received KRT.
Conclusions:
- Congenital heart disease (CHD) and congenital anomalies of the kidneys and urinary tract (CAKUT) are primary indications for KRT in neonates.
- PD utilization surpassed HD and CKRT, with increasing trends for PD and CKRT over time.
- KRT remains underutilized in neonates diagnosed with AKI.
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