Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additiona...

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Bibliographic Details
Published in:Pediatric nephrology (Berlin, West) West), 2016-11, Vol.31 (11), p.2013-2015
Main Authors: Tal, Leyat, Angelo, Joseph R., Akcan-Arikan, Ayse
Format: Article
Language:English
Subjects:
Acute kidney failure
Acute Kidney Injury
Care and treatment
Child
Diagnosis
Editorial Commentary
Humans
Infant
Infant, Newborn
Kidney
Medicine
Medicine & Public Health
Nephrology
Pediatrics
Peritoneal Dialysis
Physiological aspects
Renal Dialysis
Renal Replacement Therapy
Urology
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Summary:Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-016-3423-4