Short Term Outcomes in Neonates With Acute Kidney Injury on Peritoneal Dialysis in Renal Unit at Kenyatta National Hospital

Abstract

Acute Kidney Injury (AKI) is commonly seen in neonates and is associated with other comorbidities. Peritoneal dialysis (PD) has been the preferred modality of renal replacement therapy because it is easy to use, cheap and no associated hemodynamic constraint in the sick neonate. This study aimed at assessing the outcomes after initiation of acute peritoneal dialysis. Objectives The objectives of this study were to determine the short-outcomes (within 14 days) in neonates with acute kidney injury on peritoneal dialysis in pediatric renal unit at Kenyatta National Hospital and in a sub-analysis to determine the factors associated with the outcome. Study methodology This was a retrospective study. Records of neonates who underwent peritoneal dialysis for AKI in the pediatric renal unit at Kenyatta National Hospital between January 2016 and December 2017 were reviewed and those meeting the admission criteria were enrolled in the study. Patients with serum creatinine equal or more than 100μmol/L were considered to have AKI. The outcome was determined within 14 days of admission in the pediatric renal unit. Results A total of 92 records were reviewed and analyzed. The mortality rate was found to be at 9.8% (n=9). Complications were found in 33.7% (n= 31) of the patients and the most common was catheter leakage in 25 patients (80.6%). The median age at the start of PD was of 11 days (IQR: 9 to 13) with a median initial creatinine level of 486.5μmol/L (IQR: 338.1 to 660), a median Blood Urea Nitrogen (BUN) level of 50.4mmol/L (IQR: 37.4 to 58.7) and 50% (n= 46) reported to be anuric. Neonates spent a median of 5 days on PD (IQR: 3 to 7). There was an 82.7% decrease in Creatinine levels, an 82% decrease in BUN levels and 90.2% of the patients (n= 83) had a normal urinary output by the end of dialysis. The time spent on PD was a mean of 3 days in the patients who succumbed and 5 days in the survivor group. Neonates who dies were older (mean of 16 days) at the start of PD compared to those who survived (mean of 11 days).

Conclusion The mortality rate in neonates that underwent PD was 9.8% with a median of 5 days on PD. The complication rate was 33.7%, the commonest being catheter leakage in 80.6%. The duration on peritoneal dialysis was significantly shorter in the deceased neonates and a trend was noticed in the age at start of PD, the older the patient was, the more likely they were to die.