Application of continuous renal replacement therapy in treatment of neonatal acute kidney injury

Abstract

Objective To explore the efficacy of continuous renal replacement therapy (CRRT) in the treatment of neonatal acute kidney injury (AKI). Methods Totally 17 critically ill neonates treated with CRRT were selected who were hospitalized at Department of Neonatology, Shanghai Children′s Hospital, Children′s Hospital Affiliated to Shanghai Jiaotong University, from June 2012 to June 2017, and among them there were 15 cases with AKI, and the clinical data of these 15 patients were retrospectively analyzed, while 15 AKI neonates were treated with CRRT combined with conventional treatment.The model for CRRT was continuous veno-venous hemofiltration dialysis (CVVHDF) in 13 cases, plasma exchange (PE) in 2 cases.The changes of blood pressure(BP), renal function, electrolyte, acid-base balance index and hemodynamic indicators were analyzed respectively before CRRT treatment, 12 h, 24 h, 48 h after treatment and by the end of CRRT treatment.The efficacy of CRRT treatment was evaluated in these 15 AKI neonates. Results Gestational age of 15 AKI newborns was 33+ 4- 40+ 1 weeks, admission day age was 2-28 days, birth weight was 2.25-4.00 kg.Primary diseases were severe asphyxia in 6 cases, neonatal septicemia in 5 cases, congenital hereditary metabolic disease in 2 cases, traumatic asphyxia in 1 case, and liver failure in 1 case.CRRT treatment persisted for 49-190 hours.BP value[(50.8±6.57) mmHg(1 mmHg=0.133 kPa)] could reach normal level after 12 h CRRT treatment, and blood pH value (7.31±0.25) increased significantly after 12 h CRRT treatment, while blood K+ [(5.51±1.86) mmol/L], urea nitrogen (BUN)[(9.5±3.7) mmol/L], creatinine(Cr)[(93±14) μmol/L] significantly decreased after 12 h CRRT treatment, and reached the normal range[K+ (4.78±2.95) mmol/L, BUN (7.5±2.1) mmol/L, Cr (54±13) μmol/L] after 24 h treatment, but urine volume[(0.8±0.2) mL/(kg·h)] significantly increased after 24 h treatment.Partial pressure of oxygen/fraction of inspired oxygen reached 200 mmHg after 12 h treatment and more than 300 mmHg after 24 h treatment.CRRT treatment of 15 AKI neonates turned out to be effective. Conclusions CRRT can effectively improve the internal environment of AKI neonates and reduce the death rate of neonatal AKI, which can provide an effective adjuvant treatment measures for the treatment of AKI neonates. Key words: Continuous renal replacement therapy; Kidney injury; Infant, newborn; Efficacy; Safety