Peritoneal dialysis in very low and extremely low birthweight infants: A pooled analysis

Peritoneal Dialysis International ◽

10.1177/08968608211059888 ◽

2021 ◽

pp. 089686082110598

Author(s):

Ioannis Bellos ◽

Vasilios Karageorgiou

Keyword(s):

Peritoneal Dialysis ◽

Low Birthweight ◽

Therapeutic Option ◽

Survival Rates ◽

Kidney Injury ◽

Pooled Analysis ◽

Hazard Ratio ◽

Preterm Neonates ◽

Kidney Replacement Therapy ◽

Extremely Low Birthweight

Background: Peritoneal dialysis (PD) represents an important therapeutic option in neonatal acute kidney injury (AKI), although evidence regarding its effects in preterm neonates remains unclear. The present study aims to evaluate the feasibility of PD in very low birthweight (VLBW) and extremely low birthweight (ELBW) infants and clarify the association of catheter choice with clinical outcomes. Methods: Medline, Scopus, Web of Science, Clinicaltrials.gov and CENTRAL databases were systematically searched from inception to 15 January 2021. Studies reporting individual participant data of VLBW and ELBW infants treated with PD were selected. Results: Overall, 20 studies were included comprising 101 patients. Catheter-related complications were significantly more frequent among ELBW infants (odds ratio: 5.18, 95% confidence intervals (CI): 1.23–29.09). After inverse probability treatment weighting, compared to drainage catheters, death risk was significantly lower with the use of PD (hazard ratio: 0.42, 95% CI: 0.19–0.90) but not vascular catheters (hazard ratio: 0.58, 95% CI: 0.28–1.20). Similarly, kidney function loss was significantly lower only with the implementation of PD catheters (hazard ratio: 0.44, 95% CI: 0.21–0.94). Conclusions: PD is a feasible kidney replacement therapy modality in VLBW and ELBW infants with AKI. The use of drainage catheters may be linked to significantly worse kidney recovery and overall survival rates, compared to PD catheters. Future cohorts should confirm the most appropriate catheter type and contribute to the standardisation of PD procedures.

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Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

10.1101/2020.08.16.20175992 ◽

2020 ◽

Author(s):

Nina J Caplin ◽

Olga Zhdanova ◽

Manish Tandon ◽

Nathan Thompson ◽

Dhwanil Patel ◽

...

Keyword(s):

Intensive Care Unit ◽

New York ◽

Acute Kidney Injury ◽

New York City ◽

Renal Function ◽

Intensive Care ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

Bellevue Hospital ◽

Kidney Replacement Therapy

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy. Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position. In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

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Acute peritoneal dialysis is an efficient and reliable alternative therapy in preterm neonates with acute kidney injury

Translational Pediatrics ◽

10.21037/tp-20-469 ◽

2021 ◽

Vol 10 (4) ◽

pp. 893-899

Author(s):

Yan Xing ◽

Kai Sheng ◽

Hui Liu ◽

Song Wu ◽

Hongling Wei ◽

...

Keyword(s):

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Alternative Therapy ◽

Kidney Injury ◽

Preterm Neonates

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Strategies for Management of Peritoneal Dialysis Patients in Singapore during COVID-19 Pandemic

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020250 ◽

2020 ◽

Vol 49 (12) ◽

pp. 1025-1028

Author(s):

Htay Htay ◽

Penelope Maxine PK Wong ◽

Rui-En Ryan Choo ◽

Ubaidullah S Dawood ◽

Marjorie Wai Yin Marjorie Wai Yin Foo ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Kidney Failure ◽

Fluid Overload ◽

Kidney Injury ◽

Outbreak Response ◽

Dialysis Therapy ◽

Response System ◽

Home Based ◽

Kidney Replacement Therapy ◽

Inpatient Management

Abstract Peritoneal dialysis (PD) is the only well-established home-based dialysis therapy in Singapore. As it is a home-based modality, PD should be considered as a preferred mode of kidney replacement therapy (KRT) for patients with kidney failure during this COVID-19 pandemic as it avoids frequent visits to hospitals and/or satellite dialysis centres. The highly infectious nature of this virus has led to the implementation of the Disease Outbreak Response System Condition orange status in Singapore since early February 2020. This paper summarises the strategies for management of several aspects of PD in Singapore during this COVID-19 pandemic, including PD catheter insertion, PD training, home visit and assisted PD, outpatient PD clinic, inpatient management of PD patients with or without COVID-19 infection, PD as KRT for COVID-19 patients with acute kidney injury, management of common complications in PD (peritonitis and fluid overload), and management of PD inventory. Keywords: Home-based dialysis, kidney failure, practice, SARS-CoV-2

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Acute kidney injury in children

10.1093/med/9780199592548.003.0239 ◽

2015 ◽

Author(s):

Alexander Fichtner ◽

Franz Schaefer

Keyword(s):

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Critically Ill Children ◽

Pharmacological Intervention ◽

Preterm Neonates ◽

Technological Advances ◽

Late Start

In the past few decades, the overall incidence of acute kidney injury (AKI) in paediatric patients has increased and the aetiological spectrum has shifted from infection-related and intrinsic renal causes towards secondary forms of AKI related to exposure to nephrotoxic drugs and complex surgical, oncological, and intensive care manoeuvres. In addition, neonatal kidney impairment and haemolytic uraemic syndrome continue to be important specific paediatric causes of AKI raising unique challenges regarding prevention, diagnosis, and treatment. The search for new biomarkers is a current focus of research in paediatric as in adult AKI research.Pharmacological intervention studies to prevent or attenuate AKI have provided positive evidence only for the prophylactic use of theophylline in severely depressed neonates, whereas dopamine and loop diuretics did not demonstrate any efficacy. Preliminary findings support a dose-dependent renoprotective action of fenoldopam in infants undergoing cardiac surgery.Critical issues in the management of AKI in children include fluid handling, maintenance of adequate nutrition, and the choice of renal replacement therapy modality. Observational studies have suggested an adverse impact of fluid overload and late start of renal replacement therapy, and a randomized clinical trial revealed detrimental effects of aggressive fluid bolus therapy in volume-depleted children.Technological advances have made it possible to apply continuous replacement therapies in children of all ages, including preterm neonates, using appropriately sized catheters, filters, tubing, and flow settings adapted to paediatric needs. However, the majority of children with AKI worldwide are still treated with peritoneal dialysis, and comparative studies demonstrating superiority of extracorporeal techniques over peritoneal dialysis are lacking.The outcomes of paediatric AKI are comparable to adult patients. In critically ill children, mortality risk increases with each stage of AKI; mortality rates typically range between 15% and 30% for all AKI stages and 30% to 60% in children requiring renal replacement therapy. Chronic kidney disease develops in approximately 10% of children surviving AKI.

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