Abstract
BackgroundPeritoneal 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.MethodsIn 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.ResultsTwelve 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%.ConclusionsIn 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.
Highlights
Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI)
Indications of dialysis We applied PD in the ELBW infants with AKI, including anuria since birth or oliguria lasting over 48 h; fluid overload, including pulmonary edema; refractory hyperkalemia; severe metabolic acidosis; and uremia
Intrauterine growth retardation was more frequent in AKI infants with PD
Summary
Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). Despite the non-dialytic management of AKI among newborns, the major indications for initiating renal replacement therapy (RRT) include severe oliguria despite fluid therapy, diuretic administration, and inotropic support; refractory electrolyte imbalance; and worsening uremia [8,9,10]. A few studies reported that PD was effective for the management of AKI and metabolic disturbances in neonates, including preterm infants [10, 13]. It has been used only occasionally in ELBW infants with AKI because of unavailability of small-sized catheters and volume cyclers [14].
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