Clinical experience of peritoneal dialysis in newborns and infants in maternity clinics and hospitals without special renal replacement therapy units
AbstractCritically ill newborns are at high risk of developing acute kidney injury (AKI), which greatly increases the number of adverse outcomes. In patients with AKI, peritoneal dialysis (PD) could be a life-saving therapy. The article analyzes the experience of PD, performed by the specialists of the Center for Neonatal Nephrology and Dialysis of the Children’s City Clinical Hospital No. 9 named after G.N. Speransky (Moscow) in 100 newborn patients, born in clinics without special dialysis departments.
The aim of the study was to generalize and analyze the experience of peritoneal dialysis in children, born full-term and premature, with acute kidney injury and congenital renal failure in maternity hospitals and pediatric clinics without dialysis departments.
Material and methods. A retrospective analysis of 100 clinical cases of patients, treated with renal replacement therapy (RRT) – PD was carried out. Clinical characteristics included: medical institution, age, sex, birth weight, weight gain, creatinine level, indications for the dialysis, type, duration, and complications of RRT, main diagnosis, and outcome. The gestational age ranged from 23 weeks + 2 days to 41 weeks + 2 days (mean 33.2±6.1 weeks). 44% of children (n=44) were full-term newborns. 45 infants (45.0%) were girls and 55 (55.0%) – were boys. Birth weight ranged from 470 to 5550 g (average 2290±1153 g).
The main diagnosis for 50 patients was neonatal sepsis, 15 had severe asphyxia at birth, 8 had a combination of sepsis and asphyxia, 8 – fetal hydrops, 5 – congenital renal failure, 4 – orphan diseases (citrullinemia, galactosemia, 2 cases were unspecified), 4 – AKI, assosiated with neonatal shock (of various origin), 3 – AKI due to hypernatraemic dehydration, 1 – severe birth asphyxia, associated with placental abruption, 2 – Edwards syndrome. The majority of patients at the start of dialysis were in serious or extremely serious condition. 91% (n=91) received cardiotonic and vasopressor support, and 46% (n=46) required vasoactive therapy (adrenaline, norepinephrine, dobutamine/dopamine).
Results and discussion. Depending on the birth weight and gestation, various methods of PD were used: classical modification or flow peritoneal dialysis. The duration of RRT ranged from 1 to 60 days (7±6.9 days). The incidence of complications was 35%: catheter block in 12 (12%), local hemorrhage – 10 (10%), dialysate leakage around the catheter – 9 (9%), dialysis peritonitis – 5 (5%), intestinal perforation – 3 (3%). In 1 (1%) case, catheter loss was noted when using Blake drainage, in 1 (1%) case ultrafiltration was insufficient.
Conclusion. Dialysis technologies are increasingly being used in neonatal practice, although so far most publications contain a small number of cases. The accumulation of clinical experience contributes to the early and timely start of RRT in critically ill neonates, which can significantly reduce mortality and improve outcomes in patients with AKI.
Keywords:acute kidney injury; congenital renal failure; newborns; premature newborns; dialysis; renal replacement therapy; peritoneal dialysis
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Makulova A.I., Tukabaev G.P., Zolotareva L.S., Toporkova A.O., Abaseeva T.Yu., Mashtak N.A., Fomenko S.A., Toporkov R.V., Ulitina S.V., Karpysheva E.V., Bakhmatov G.V., Kholodnova N.V., Drozdovskaia V.V., Kondrashkina A.S., Мicevichus E.V., Orekhova S.B., Korsunskiy A.A. Clinical experience of peritoneal dialysis in newborns and infants in maternity clinics and hospitals without special renal replacement therapy units. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2023; 11 (1): 19–27. DOI: https://doi.org/10.33029/2308-2402-2023-11-1-19-27 (in Russian)
Received 20.09.2022. Accepted 06.02.2023.
REFERENCES
1. Jetton J.G., Boohaker L.J., Sethi S.K., Wazir S., Rohatgi S., Soranno D.E., et al.; Neonatal Kidney Collaborative (NKC). Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health. 2017; 1 (3): 184–94.
2. Ranchin B., Plaisant F., Demède D., de Guillebon J.M., Javouhey E., Bacchetta J. Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed. Acta Paediatr. 2021; 110 (3): 781–8.
3. Sethi S.K., Agrawal G., Wazir S., Rohatgi S., Iyengar A., Chakraborty R., et al. Neonatal acute kidney injury: A survey of perceptions and management strategies amongst pediatricians and neonatologists. Front Pediatr. 2020; 7: 553.
4. Abaseeva T.Yu., Makulova A.I., Zolotareva L.S., Tukabaev G.P., Tarbeeva O.M., Zaitseva O.V., et al. Neonatal acute kidney injury: awareness of physicians of neonatal intensive care units and doctors of another pediatric profile. Pediatriya [Pediatria named after G.N. Speransky]. 2021; 100 (4): 40–8. (in Russian)
5. Okan M.A., Topçuoglu S., Karadag N.N., Ozalkaya E., Karatepe H.O, Vardar G., et al. Acute Peritoneal Dialysis in Premature Infants. Indian Pediatr. 2020; 57 (5): 420–2.
6. Bellos I., Karageorgiou V. Peritoneal dialysis in very low and extremely low birthweight infants: A pooled analysis. Perit Dial Int. 2022; 42 (5): 470–81. DOI: https://doi.org/10.1177/08968608211059888
7. Elgendy M.M., Othman H.F., Mohamed M.A., Matar R.B., Aly H. Kidney replacement therapy in neonates: utilization trends and outcomes. Pediatr Nephrol. 2023; 38 (3): 867–76. DOI: https://doi.org/10.1007/s00467-02205575-5
8. Sethi S.K., Wazir S., Sahoo J., Agrawal G., Bajaj N., Gupta N.P., et al. Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study. Perit Dial Int. 2022; 42 (5): 460–9. DOI: https://doi.org/10.1177/08968608221091023
9. Özlü F., Yapıcıoğlu Yıldızdaş H., Şeker G., Şimşek H., Karabay Bayazıt A., Satar M. Peritoneal dialysis in neonates: six years of single center experience. Turk J Med Sci. 2018; 48 (2): 231–6.
10. Xing Y., Sheng K., Liu H., Wu S., Wei H., Li R., et at. Acute peritoneal dialysis is an efficient and reliable alternative therapy in preterm neonates with acute kidney injury. Transl Pediatr. 2021; 10 (4): 893–9.
11. Noh J., Kim C.Y., Jung E., Lee J.H., Park Y.S., Lee B.S., et al. Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study. BMC Nephrol. 2020; 21 (1): 437.
12. Akbalık Kara M., Pınarbaşı A.S., Çelik M. Peritoneal dialysis for term neonates in a neonatal intensive care unit. Pediatr Int. 2022; 64 (1): e15155.
13. Kara A., Gurgoze M.K., Aydin M., Taskin E., Bakal U, Orman A. Acute peritoneal dialysis in neonatal intensive care unit: An 8-year experience of a referral hospital. Pediatr Neonatol. 2018; 59 (4): 375–9.
14. Charlton J.R., Boohaker L., Askenazi D., Brophy P.D., D’Angio C., Fuloria M., et al.; Neonatal Kidney Collaborative. Incidence and risk factors of early onset neonatal AKI. Clin J Am Soc Nephrol. 2019; 14 (2): 184–95.
15. Chugunova O.L., Ivanov D.O., Kozlova E.M., Safina A.I., Zverev D.V., Daminova M.A., et al. Acute kidney injury in newborns (draft clinical recommendations dated 04/29/2019) Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2019; 7 (2): 68–81. (in Russian)
16. Zappitelli M., Ambalavanan N., Askenazi D.J., Moxey-Mims M.M., Kimmel P.L., Star R.A., et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res. 2017; 82 (4): 569–73.
17. Sanderson K.R., Warady B., Carey W., Tolia V., Boynton M.H., Benjamin D.K., et al. Mortality risk factors among infants receiving dialysis in the neonatal intensive care unit. J Pediatr. 2022; 242: 159–65.
18. Matsushita F.Y., Krebs V.L.J., de Carvalho W.B. Association between fluid overload and mortality in newborns: a systematic review and meta-analysis. Pediatr Nephrol. 2022; 37 (5): 983–92.
19. Kadivar M., Sangsari R., Mirnia K., Abbasi A., Rabipour M. Peritoneal dialysis in neonates: A five-year experience. Iranian Journal of Neonatology. 2020: 11 (4): 64–8. DOI: https://doi.org/10.22038/ijn.2020.44569.1738
20. Starr M.C., Charlton J.R., Guillet R., Reidy K., Tipple T.E., Jetton J.G., et al. Advances in neonatal acute kidney injury. Pediatrics. 2021; 148 (5): e2021051220. DOI: https://doi.org/10.1542/peds.2021-051220