Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study
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RESEARCH ARTICLE
Open Access
Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study Jihyun Noh1, Chae Young Kim2, Euiseok Jung1* , Joo Hoon Lee1, Young-Seo Park1, Byong Sop Lee1, Ellen Ai-Rhan Kim1 and Ki-Soo Kim1
Abstract Background: Peritoneal 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. Methods: In 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. Results: Twelve 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%. Conclusions: In 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. Keywords: Acute kidney injury, Infants, Extremely low birth weight, Peritoneal dialysis, Hyperkalemia
Background Although the precise incidence and prevalence rates of acute kidney injury (AKI) among newborns are unknown, it is commonly observed in the neonatal intensive care unit (NICU), with rates approximately ranging from 8 to 24% [1]. Neonates with AKI have very high mortality rates, i.e., * Correspondence: [email protected] 1 Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea Full list of author information is available at the end of the article
4.5–78% [1–3]. AKI has a significant impact on the survival rates of preterm infants. Because the kidneys of extremelylow-birth-weight (ELBW; birth weight, < 1000 g) infants are immature and susceptible to environmental factors, including infectious pathogens and nephrotoxic medications, prevalence of AKI among ELBW is around 56% [4, 5]. Renal hypoperfusion and ischemia, with or without septic shock, account for 18% of AKI among ELBW infants [4
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