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Short-term survival of hyperammonemic neonates treated with dialysis

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Abstract

Background

In severe neonatal hyperammonemia, extracorporeal dialysis (ECD) provides higher ammonium clearance than peritoneal dialysis (PD). However, there are limited outcome data in relation to dialysis modality.

Methods

Data from infants with hyperammonemia secondary to inborn errors of metabolism (IEM) treated with dialysis were collected in six Italian centers and retrospectively analyzed.

Results

Forty-five neonates born between 1990 and 2011 were enrolled in the study. Of these, 23 were treated with PD and 22 with ECD (14 with continuous venovenous hemodialysis [CVVHD], 5 with continuous arteriovenous hemodialysis [CAVHD], 3 with hemodialysis [HD]). Patients treated with PD experienced a shorter duration of predialysis coma, while those treated with HD had a shorter ammonium decay time compared with all the other patients (p < 0.05). No difference in ammonium reduction rate was observed between patients treated with PD, CAVHD or CVVHD. Carbamoyl phosphate synthetase deficiency (CPS) was significantly associated with increased risk of death (OR: 9.37 [1.52–57.6], p = 0.016). Predialysis ammonium levels were significantly associated with a composite end-point of death or neurological sequelae (adjusted OR: 1.13 [1.02–1.27] per 100 μmol/l, p = 0.026). No association was found between outcome and dialysis modality.

Conclusions

In this study, a delayed ECD treatment was not superior to PD in improving the short-term outcome of neonates with hyperammonemia secondary to IEM.

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Disclosure

The results presented in this paper have not been published previously in whole or in part.

All the authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Nephrology and Dialysis Unit, Department of Nephrology—Urology, “Bambino Gesù” Children’s Hospital–IRCCS, Rome, Italy

    Stefano Picca & Francesco Emma

  2. Division of Metabolism, “Bambino Gesù” Children’s Research Hospita–IRCCS, Rome, Italy

    Carlo Dionisi-Vici

  3. Rare Disease Unit, “Bambino Gesù” Children’s Research Hospita–IRCCS, Rome, Italy

    Andrea Bartuli

  4. Pediatric Nephrology and Dialysis Unit, Children′s Hospital Giovanni XXIII, Bari, Italy

    Tommaso De Palo

  5. Metabolic Diseases and Clinical Genetics Unit, Children′s Hospital Giovanni XXIII, Bari, Italy

    Francesco Papadia

  6. Department of Pediatrics, Azienda Ospedaliero-Universitaria Sant’Orsola-Malpighi Bologna, Bologna, Italy

    Giovanni Montini

  7. Pediatric Nephrology and Dialysis Unit, Meyer Hospital, Florence, Italy

    Marco Materassi

  8. Metabolic and Neuromuscular Unit, Meyer Hospital, Florence, Italy

    Maria Alice Donati

  9. Dialysis Unit, Nephrology Division, G. Gaslini Institute, Genoa, Italy

    Enrico Verrina

  10. Department of Paediatrics, G. Gaslini Institute, Genoa, Italy

    Maria Cristina Schiaffino

  11. Pediatric Nephrology and Dialysis Unit, Santobono Children′s Hospital, Naples, Italy

    Carmine Pecoraro

  12. Neonatology Unit, Santobono Children′s Hospital, Naples, Italy

    Emilia Iaccarino

  13. Pediatric Nephrology, Dialysis and Transplant Unit, University Hospital, Padua, Italy

    Enrico Vidal

  14. Division of Inborn Metabolic Diseases, Department of Pediatrics, University Hospital, Padua, Italy

    Alberto Burlina

Authors
  1. Stefano Picca
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  2. Carlo Dionisi-Vici
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  3. Andrea Bartuli
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  6. Giovanni Montini
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  7. Marco Materassi
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  8. Maria Alice Donati
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  12. Emilia Iaccarino
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  14. Alberto Burlina
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  15. Francesco Emma
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Corresponding author

Correspondence to Stefano Picca.

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Picca, S., Dionisi-Vici, C., Bartuli, A. et al. Short-term survival of hyperammonemic neonates treated with dialysis. Pediatr Nephrol 30, 839–847 (2015). https://doi.org/10.1007/s00467-014-2945-x

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  • DOI: https://doi.org/10.1007/s00467-014-2945-x

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