Peritoneal dialysis for extremely low birth weight infants
Objective: We determined the mortality ratio and risk factors of peritoneal dialysis (PD) in the treatment of acute kidney injury (AKI) in extremely low birth weight (ELBW) infants. Methods: PD was performed in 14 ELBW infants (9 males and 5 females) from 1997 to 2010, out of more than 151 total ELBW infants seen during that period. Treatment with PD fluid was started at 10 ml/kg and gradually increased to 40 ml/kg checking for leakage and hyperglycemia, with a storage time of 60-90 min/cycle continuing for 24 hours. Results: Fourteen ELBW infants were treated, 9 of whom were successfully weaned (6 infants died within several weeks after discontinuation and 3 survived). The mortality rate of patients treated with PD (9.2% of all ELBWI infants) was 79%. Patients that had complications involving fewer organs survived. All patients who received PD and suffered from intracranial hemorrhage, necrotizing enterocolitis, or disseminated intravascular coagulation died. Among the 7 patients with patent ductus arteriosus for whom PD was performed, 6 died. Among the 3 patients with pulmonary hemorrhage for whom PD was performed, 2 died. Patients who survived were weaned off PD within 6 days. The side effects of treatment included hyperglycemia, peritonitis, leakage of the PD fluid, and catheter obstruction. Conclusions: Mortality of ELBW infants with AKI is quite high because patients' organs are immature and, therefore, often have other organ failures; however, PD itself can be performed safely. Starting PD treatment before the onset of anuria may improve the survival rate of ELBW infants with AKI.