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. 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.
Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Leyat
L
Tal
Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Joseph R
JR
Angelo
Renal Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. aysea@bcm.edu.|Section of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Houston, TX, 77030, USA. aysea@bcm.edu.
Ayse
A
Akcan-Arikan
D058186:Acute Kidney Injury; D002648:Child; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney; D010530:Peritoneal Dialysis; D006435:Renal Dialysis; D017582:Renal Replacement Therapy
Acute kidney injury; Continuous venovenous hemodiafiltration; Extracorporeal continuous renal replacement therapy; Neonates; nRIFLE