Multisite Retrospective Review of Outcomes in Renal Replacement Therapy for Neonates with Inborn Errors of Metabolism - 22/06/22
, Corey Powell, PhD 2, Rachel M. Engen, MD 3, Donald J. Weaver, MD, PhD 4, Asif Mansuri, MD 5, Michelle N. Rheault, MD 6, Keia Sanderson, MD, MSCR 7, Uta Lichter-Konecki, MD, PhD 8, Ankana Daga, MBBS 9, Lindsay C. Burrage, MD, PhD 10, 11, Ayesha Ahmad, MD 1, Scott E. Wenderfer, MD 10, 11, Kera E. Luckritz, DO 12Abstract |
Objective |
To assess the outcomes of neonates in a contemporary multi-institutional cohort who receive renal replacement therapy (RRT) for hyperammonemia.
Study design |
We performed a retrospective analysis of 51 neonatal patients with confirmed inborn errors of metabolism that were treated at 9 different children's hospitals in the US between 2000 and 2015.
Results |
Twenty-nine patients received hemodialysis (57%), 21 patients received continuous renal replacement therapy (41%), and 1 patient received peritoneal dialysis (2%). The median age at admission of both survivors (n = 33 [65%]) and nonsurvivors (n = 18) was 3 days. Peak ammonia and ammonia at admission were not significantly different between survivors and nonsurvivors. Hemodialysis, having more than 1 indication for RRT in addition to hyperammonemia, and complications during RRT were all risk factors for mortality. After accounting for multiple patient factors by multivariable analyses, hemodialysis was associated with a higher risk of death compared with continuous renal replacement therapy. When clinical factors including evidence of renal dysfunction, number of complications, concurrent extracorporeal membrane oxygenation, vasopressor requirement, and degree of hyperammonemia were held constant in a single Cox regression model, the hazard ratio for death with hemodialysis was 4.07 (95% CI 0.908-18.2, P value = .067). To help providers caring for neonates with hyperammonemia understand their patient's likelihood of survival, we created a predictive model with input variables known at the start of RRT.
Conclusions |
Our large, multicenter retrospective review supports the use of continuous renal replacement therapy for neonatal hyperammonemia.
Le texte complet de cet article est disponible en PDF.Keywords : ammonia, dialysis, IEM, RRT, survival
Abbreviations : AKI, BSA, CRRT, CVVHD, CVVHDF, ECMO, HR, IEM, OA, RRT, UCD
Plan
| Supported by the Gerber Foundation, Fremont, MI (N026404-391375 to E.A). The authors declare no conflicts of interest. |
|
| Portions of this study were presented as a oral presentation during the Neonatal Kidney Collaborative meeting, May 4, 2020, Virtual. |
Vol 246
P. 116 - juillet 2022 Retour au numéro
Article précédent
- Acute Pancreatitis Is Associated with Increased Risk of In-Hospital Mortality and Health Care Utilization Among Pediatric Patients with Hematopoietic Stem Cell Transplantation
- Aravind Thavamani, Krishna Kishore Umapathi, Jignesh Dalal, Thomas J. Sferra, Senthilkumar Sankararaman
- 50 Years Ago in The Journal of Pediatrics : Rickets and Antiepileptic Drugs: What Have We Learned?
- Brittany Espino, Morri Markowitz
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?