109 - Kidney replacement therapy in newborn infants diagnosed with acute kidney injury
Friday, April 22, 2022
6:15 PM – 8:45 PM US MT
Poster Number: 109 Publication Number: 109.125
Marwa M. Elgendy, Cleveland Clinic Children's Hospital, cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States; Hasan F. Othman, Michigan State University College of Human Medicine, Lansing, MI, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States
Neonatology Fellow Cleveland Clinic Children's Hospital Cleveland Clinic Children's Hospital cleveland, Ohio, United States
Background: Acute kidney injury (AKI) is independently associated with increased mortality in newborn infants. Kidney replacement therapy (KRT) is a lifesaver for newborn infants who have AKI.
Objective: To assess the prevalence of utilization of peritoneal dialysis (PD) and hemodialysis (HD) as KRT in infants diagnosed with AKI and to examine the associated comorbidities and outcomes of these infants.
Design/Methods: Data were obtained from the National Inpatient Sample (NIS) database from 2000 to 2017. All newborns (age <28 days) diagnosed with AKI were included in this study. We identified infants with diagnostic codes for AKI, and procedure codes for PD and HD. We extracted data on gestational age (GA), birth weight (BW) and multiple comorbidities.
Results: A total of 64,532,552 neonatal records were reviewed in the dataset, of them 51,736 newborn infants were diagnosed with AKI and did not receive KRT, while only 2688 infants had AKI and treated with KRT. A total of 1732 (64%) of AKI treated infants received PD while 1055 (39%) of treated infants received hemodialysis and 99 (3.6%) infants received both types of dialyses. Infants diagnosed with AKI and treated with KRT had increased mortality (48.5%) compared to AKI infants who did not receive dialysis (30.3%), p< 0.01. This study reported that 20.2% of infants received PD were premature with GA < 37 weeks while only 9.9% of preterm infants were treated with hemodialysis. Hemodialysis was associated with increased mortality rate compared to PD (63.3% vs 39%, p< 0.01, respectively) Table 1. Complication related to PD were peritonitis (9%), peritoneal leak (8%). Intraventricular hemorrhage (IVH) and hypoxic ischemic encephalopathy (HIE) were higher in infants received HD than PD (11.1% vs 7.9% & 7.1% vs 3.7%, p< 0.01 respectively).Conclusion(s): Kidney replacement therapy (KRT) is feasible in newborn infants including premature infants, as well. The risk for complications associated with PD and HD was low. This study highlights the need for establishing guidelines in using KRT in newborns to minimized variation in practice and disparities in offered services.