Efficacy of Peritoneal Dialysis in Acute Kidney Injury in Neonates with Hypoxic-Ischemic Encephalopathy Treated with Therapeutic Hypothermia.

Abstract

We aimed to evaluate the efficacy of peritoneal dialysis (PD) in hypoxic-ischemic acute kidney injury (AKI) in newborns with hypoxic-ischemic encephalopathy (HIE) who underwent therapeutic hypothermia (TH). This was a retrospective study including the newborns with HIE/TH who developed hypoxic-ischemic AKI and underwent PD between January 2022 and June 2024. The blood test results obtained before starting PD were compared with the blood test results obtained just before the decision to terminate PD or, in case of death, with the final blood test results obtained before death. Twenty-one newborns were included in the study. Four (19%) of these newborns were diagnosed with moderate HIE, and 17 (81%) were diagnosed with severe HIE. The median gestational age of the patients was 38 (36-39) weeks, and the mean birth weight was 3083 ± 494 g. The median postnatal day when PD started was 3 (2-4) days and its duration was 7 (4-10) days. All patients had fluid overload as an indication for PD dialysis, and fluid overload was accompanied by hyperkalemia in 8 (38.1%) patients. After PD, blood pH, bicarbonate, and sodium values increased significantly (p ≤ 0.001, 0.009, <0.001, respectively), and potassium, phosphorus, and creatinine values decreased significantly (p ≤ 0.001, <0.001, 0.031, respectively) compared with the predialysis values. PD corrects acidosis and electrolyte imbalance and may be considered as a successful renal replacement therapy for hypoxic-ischemic AKI in neonates with HIE/TH, especially in units with limited resources.