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

BACKGROUND: This study aimed to assess the underlying causes and outcomes of acute peritoneal dialysis (APD) and the complications of PD procedure in preterm neonates with acute kidney injury (AKI). METHODS: A retrospective study of 21 preterm neonates who underwent APD in a neonatal intensive care unit (NICU) in Peking University Third Hospital between 2016 and 2019 was conducted. The demographic, clinical, biochemistry, and PD procedure­-related information of the neonates was analyzed. RESULTS: Of the 21 preterm neonates, the average gestational age (GA) was 28.9±2.6 weeks, and the average birth weight was 1,226.7±495.3 g, and included 5 (23.8%) low-birth-weight infants (LBWIs), 7 (33.3%) very LBWIs (VLBWIs), and 9 (42.9%) extremely LBWIs (ELBWIs). The major underlying causes for APD were asphyxia (66.7%, n=14) and twin-twin transfusion syndrome (47.6%, n=10). PD procedure-related complications mainly involved inadequate drainage (n=5, 23.8%) and drainage infections (n=2, 9.5%). The median duration of PD was 3 days (range, 1 hour–20 days). Compared to pre-PD, blood urea nitrogen (BUN) and serum K(+) levels were significantly decreased post-PD (P<0.05). After PD, edema disappeared in 77.8% (n=14/18) of patients, and 42.9% patients (n=9/21) gained normal urine output. Although 8 of the 21 (38.1%) patients died and 6 (29.6%) abandoned therapy, 7 (33.3%) patients including 1 VLBWI and 3 ELBWI survived. CONCLUSIONS: APD is an efficient and reliable alternative route of renal replacement therapy particularly for reducing BUN and K(+) levels in preterm neonates with AKI. APD is practicable in critically ill preterm neonates, even in LBWIs and ELBWIs.