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

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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.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Neonatology, Fujian Province, Quanzhou Maternity and Children’s Hospital, Fengze Street, No 700, Quanzhou, 362000, China

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

Authors
  1. Jinglin Xu
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  2. Lingyu Fang
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  3. Jiangbin Chen
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  4. Xinhua Chen
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  5. Hansong Yang
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  6. Weifeng Zhang
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  7. Lianqiang Wu
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  8. Dongmei Chen
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Contributions

Jinglin Xu and Dongmei Chen contributed to the study’s conception and design. Material preparation, data collection, and analysis were performed by Jinglin Xu, Lingyu Fang, and Lianqiang Wu. The first draft of the manuscript was written by Jinglin Xu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Dongmei Chen.

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Considering this is an observational study, the Medical Ethics Committee of Quanzhou Maternity and Children’s Hospital has confirmed that no ethical approval is required.

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The authors declare no competing interests.

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Xu, J., Fang, L., Chen, J. et al. Real-life effects, complications, and outcomes in 39 critically ill neonates receiving continuous kidney replacement therapy. Pediatr Nephrol 38, 3145–3152 (2023). https://doi.org/10.1007/s00467-023-05944-8

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  • DOI: https://doi.org/10.1007/s00467-023-05944-8

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