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Pediatric Nephrology
Published in: Pediatric Nephrology 9/2023

29-03-2023 | Acute Kidney Injury | Original Article

Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy

Authors: Jinglin Xu, Lingyu Fang, Jiangbin Chen, Xinhua Chen, Hansong Yang, Weifeng Zhang, Lianqiang Wu, Dongmei Chen

Published in: Pediatric Nephrology | Issue 9/2023

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Abstract

Background

Continuous kidney replacement therapy (CKRT) has been expanded from simple kidney replacement therapy to the field of critical illness in children. However, CKRT is rarely used in critically ill neonates in the neonatal intensive care unit (NICU). This study aimed to describe patients’ clinical characteristics at admission and CKRT initiation, CKRT effects, short-term outcomes, and predictors of death in critically ill neonates.

Methods

A 7-year single-center retrospective study in a tertiary NICU.

Results

Thirty-nine critically ill neonates received CKRT between May 2015 and April 2022 with a mortality rate of 35.9%. The most common primary diagnosis was neonatal sepsis in 15 cases (38.5%). Continuous veno-venous hemodiafiltration and continuous veno-venous hemofiltration were applied in 43.6% and 56.4% of neonates, respectively. The duration of CKRT was 44 (18, 72) h. Thirty-one patients (79.5%) had complications due to CKRT-related adverse events, and the most common complication was thrombocytopenia. Approximately 12 h after the CKRT initiation, urine volume, mean arterial pressure, and pH were increased, and serum creatinine, blood urea nitrogen, and blood lactate were decreased. In the multivariate logistic regression analysis, neonatal critical illness score [odds ratio 0.886 (0.786 ~ 0.998), P = 0.046] was an independent risk factor for death in critically ill neonates who received CKRT.

Conclusions

CKRT can be an effective and feasible technique in critically ill neonates, but the overall mortality and CKRT-related complications are relatively high. Furthermore, the probability of death is greater among neonates with greater severity of illness at CKRT initiation.

Graphical abstract

Appendix
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Metadata
Title
Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy
Authors
Jinglin Xu
Lingyu Fang
Jiangbin Chen
Xinhua Chen
Hansong Yang
Weifeng Zhang
Lianqiang Wu
Dongmei Chen
Publication date
29-03-2023
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 9/2023
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-023-05944-8

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