Real-world modality selection and outcomes in neonatal kidney replacement therapy: a single-center cohort study

Area of Science:

• Neonatal Medicine
• Pediatric Nephrology
• Critical Care

Background:

• Neonatal kidney replacement therapy (KRT) is crucial for critically ill infants.
• Peritoneal dialysis (PD) is traditionally favored for its feasibility in neonates.
• Continuous kidney replacement therapy (CKRT) offers faster solute clearance but is more complex.

Purpose of the Study:

• To compare biochemical and clinical outcomes of PD and CKRT in neonates.
• To identify factors associated with mortality in neonates undergoing KRT.
• To evaluate the effectiveness of sequential PD + CKRT.

Main Methods:

• Retrospective single-center study of neonates undergoing KRT (2013-2025).
• Patients categorized into PD, CKRT, or sequential PD + CKRT groups.
• Analysis of demographics, indications, biochemical response, complications, and outcomes.

Main Results:

• CKRT showed faster early reductions in BUN, creatinine, and ammonia/leucine compared to PD.
• End-of-treatment biochemical outcomes and survival rates were similar between modalities.
• KRT-related complications were independently associated with mortality (OR 12.69, p=0.024).

Conclusions:

• Both PD and CKRT provide acceptable outcomes when tailored to patient needs.
• KRT complications, rather than modality, are linked to mortality, reflecting illness severity.
• Further multicenter studies are needed to guide KRT modality selection in neonates.