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Short-term results of continuous venovenous haemodiafiltration versus peritoneal dialysis in 40 neonates with inborn errors of metabolism

European Journal of Pediatrics volume 178, pages 829–836 (2019)Cite this article

Abstract

Several recent studies have reported that toxic metabolites accumulated in the body as a product of inborn errors of metabolism (IEM) are eliminated more rapidly with continuous venovenous hemodiafiltration (CVVHDF) than with peritoneal dialysis (PD). However, there is still uncertainty about the impacts of dialysis modalities on the short-term outcome. Here, it was aimed to investigate the effects of dialysis modalities on the short-term outcome. This retrospective study included 40 newborn infants who underwent PD (29 patients) or CVVHDF (11 patients) due to inborn errors of metabolism at a tertiary centre, between June 2013 and March 2018. The outcomes and the potential effects of the dialysis modality were evaluated. Of 40 patients, 21 were urea cycle defect, 14 were organic academia, and 5 were maple syrup urine disease. The median 50% reduction time of toxic metabolites were shorter in patients treated with CVVHDF (p < 0.05). Catheter blockage was the most common complication observed in PD group (24.1%), whereas in CVVHDF group hypotension and filter blockage were more common. There was no significant difference in mortality between dialysis groups (38% vs. 45.4%, p > 0.05). In patients with hyperammonaemia, duration of plasma ammonia > 200 μg/dL was the most important factor influencing mortality (OR 1.05, CI 1.01–1.09, p = 0.007).

Conclusion: This study showed that CVVHDF is more efficient than PD to rapidly eliminate toxic metabolites caused by IEM in newborn infants, but not in improving survival.

What is Known:
•Toxic metabolites are eliminated more rapidly with CVVHDF than with PD.
•Higher complication rates were reported with rigid peritoneal catheters in PD and catheter blockage in CVVHDF.
What is New:
•Prolonged duration of plasma ammonia levels above a safe limit (200 μg/dL) was associated with increased mortality.
•Lower catheter-related complication rates may have been associated with the use of Tenckhoff catheters in PD and the use of right internal jugular vein in CVVHDF.

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Abbreviations

aPTT :

Active partial thromboplastin time

ASA :

Argininosuccinic aciduria

CAVHD :

Continuous arteriovenous haemodialysis

CIT :

Citrulliaemia

CPS :

Carbamoyl phosphate synthetase deficiency

CRRT :

Continuous renal replacement therapy

CVVHD :

Continuous venovenous haemodialysis

CVVHDF :

Continuous venovenous haemodiafiltration

ECD :

Extracorporeal dialysis

HD :

Haemodialysis

MMA :

Methylmalonic acidaemia

MSUD :

Maple syrup urine disease

OA :

Organic acidaemia

OTC :

Ornithine transcarbamylase deficiency

PD :

Peritoneal dialysis

PO :

Per oral

PPA :

Propionic acidaemia

UCD :

Urea cycle disorder

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Affiliations

  1. Department of Pediatrics, Division of Neonatology, Gaziantep University, Osmangazi Mahallesi, Üniversite Blv., 27310 Şehitkamil, Gaziantep, Turkey

    Muhittin Celik

  2. Department of Pediatrics, Division of Pediatric Cardiology, Diyarbakir Children’s Diseases Hospital, Diyarbakir, Turkey

    Osman Akdeniz

  3. Department of Pediatrics, Division of Pediatric Neurology, Diyarbakir Children’s Diseases Hospital, Diyarbakir, Turkey

    Nezir Ozgun

  4. Department of Pediatrics, Division of Neonatology, Memorial Dicle Hospital, Diyarbakir, Turkey

    Mehmet Sah Ipek

  5. Department of Pediatrics, Division of Pediatric Endocrinology and Metabolism, Gazi Yaşargil Training and Research Hospital, Diyarbakir, Turkey

    Mehmet Nuri Ozbek

Authors
  1. Muhittin Celik
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  2. Osman Akdeniz
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  3. Nezir Ozgun
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  4. Mehmet Sah Ipek
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  5. Mehmet Nuri Ozbek
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Contributions

M.C.: conception, analysis of data, write the first draft of the manuscript, the literature search and full text acquisition; O.A. and N.O.: analysis of data, literature search, and revise the manuscript; M.S.I and M.N.O.: cross-check the data, appraise the quality of the studies; all authors contributed important intellectual content in drafting and revising the manuscript and approved the final version for submission.

Corresponding author

Correspondence to Muhittin Celik.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Clinical Research Ethics Board (Registration Number: 29/12/2017-108).

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The authors declare that they have no conflict of interest.

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Written informed consent was obtained from all parents’ individual participants included in the study.

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Celik, M., Akdeniz, O., Ozgun, N. et al. Short-term results of continuous venovenous haemodiafiltration versus peritoneal dialysis in 40 neonates with inborn errors of metabolism. Eur J Pediatr 178, 829–836 (2019). https://doi.org/10.1007/s00431-019-03361-4

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Keywords

  • Continuous venovenous hemodiafiltration
  • Inborn errors of metabolism
  • Newborn
  • Peritoneal dialysis