Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study
Background: Acute kidney injury (AKI) is common in neonates admitted to neonatal intensive care units (NICUs). There is a need to have prospective data on the risk factors and outcomes of acute peritoneal dialysis (PD) in neonates. The use of kidney replacement therapy in this population compared to older populations has been associated with worse outcomes (mortality rates 17-24%) along with a longer stay in the NICU and/or hospital.
Methods: The following multicentre, prospective study was derived from the TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) database, assessing all admitted neonates ≤28 days who received intravenous fluids for at least 48 h. The following neonates were excluded: death within 48 h, presence of any lethal chromosomal anomaly, requirement of congenital heart surgery within the first 7 days of life and those receiving only routine care in nursery. Demographic data (maternal and neonatal) and daily clinical and laboratory parameters were recorded. AKI was defined according to the Neonatal Kidney Disease: Improving Global Outcomes criteria.
Results: Of the included 1600 neonates, a total of 491 (30.7%) had AKI. Of these 491 neonates with AKI, 44 (9%) required PD. Among neonates with AKI, the odds of needing PD was significantly higher among those with significant cardiac disease (odds ratio (95% confidence interval): 4.95 (2.39-10.27); p < 0.001), inotropes usage (4.77 (1.98-11.51); p < 0.001), severe peripartum event (4.37 (1.31-14.57); p = 0.02), requirement of respiratory support in NICU (4.17 (1.00-17.59); p = 0.04), necrotising enterocolitis (3.96 (1.21-13.02); p = 0.03), any grade of intraventricular haemorrhage (3.71 (1.63-8.45); p = 0.001), evidence of fluid overload during the first 12 h in NICU (3.69 (1.27-10.70); p = 0.02) and requirement of resuscitation in the delivery room (2.72 (1.45-5.12); p = 0.001). AKI neonates with PD as compared to those without PD had a significantly lower median (interquartile range) duration of stay in NICU (7 (4-14) vs. 11 (6-21) days; p = 0.004), but significantly higher mortality (31 (70.5%) vs. 50 (3.2%); p < 0.001). This discrepancy is likely attributable to the critical state of the neonates with AKI.
Conclusions: This is the largest prospective, multicentre study specifically looking at neonatal AKI and need for dialysis in neonates. AKI was seen in 30.7% of neonates (with the need for acute PD in 9% of the AKI group). The odds of needing acute PD were significantly higher among those with significant cardiac disease, inotropes usage, severe peripartum event, requirement of respiratory support in NICU, necrotising enterocolitis, any grade of intraventricular haemorrhage, evidence of fluid overload more than 10% during the first 12 h in NICU and requirement of resuscitation in the delivery room. AKI neonates with PD as compared to AKI neonates without PD had a significantly higher mortality. There is a need to keep a vigilant watch in neonates with risk factors for the development of AKI and need for PD.
Sidharth Kumar Sethi
Sanjay Wazir
Jagdish Sahoo
Gopal Agrawal
Naveen Bajaj
Naveen Parkash Gupta
Shishir Mirgunde
Binesh Balachandran
Kamran Afzal
Anubha Shrivastava
Jyoti Bagla
Sushma Krishnegowda
Ananth Konapur
Azmeri Sultana
Kritika Soni
Nikhil Nair
Divya Sharma
Prajit Khooblall
Avisha Pandey
Khalid Alhasan
Mignon McCulloch
Timothy Bunchman
Abhishek Tibrewal
Rupesh Raina
Perit Dial Int
. 2022 Sep;42(5):460-469. doi: 10.1177/08968608221091023. Epub 2022 May 16.
2022
English
The underrated role of ultrasound in peritoneal dialysis.
The application of ultrasound (US) in peritoneal dialysis (PD) started in the 90s, focusing on common clinical aspects such as exit site and tunnel infections.1-3 In the new millennium, US was evaluated as an aid to percutaneous catheter placement and for the study of catheter malfunction.4-10 In case reports or case series, US was useful in detecting complications such as adhesion,11, 12 hernia,13, 14 leakage,15 cyst formation,16 or pleuroperitoneal communication17 often anticipating or confirming the diagnosis of other radiological techniques such as computed tomography or nuclear magnetic resonance. In daily clinical practice, bedside US seems to have an underrated role despite its considerable diagnostic power. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinical nephrologist.
Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost- and time-saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinician.
Granata A; Rahbari E; Di Nicolò P; Battaglia Y; Campo I; Fresilli D; Pacini P; Lucatelli P; Barr RG; Cantisani V; Zeiler M
Journal Of Ultrasound In Medicine
2021
2021-03-29
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.1002/jum.15710">http://doi.org/10.1002/jum.15710</a></td>
</tr></tbody></table>
Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique
All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys.
Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique.
Smith B; Mirhaidari S; Shoemaker A; Douglas D; Dan AG
JSLS-Journal Of The Society Of Laparoendoscopic Surgeons
2021
Journal Article
<table width="91" style="border-collapse:collapse;width:68pt;"><colgroup><col width="91" style="width:68pt;" /></colgroup><tbody><tr style="height:15pt;"><td width="91" height="20" class="xl18" style="width:68pt;height:15pt;"><a href="http://doi.org/10.4293/JSLS.2020.00115">http://doi.org/10.4293/JSLS.2020.00115</a></td>
</tr></tbody></table>
Outcomes of Laparoscopic Peritoneal Dialysis Catheter Placement Using an Optimal Placement Technique
Laparoscopy; Catheter placement; PD catheter; Peritoneal dialysis
Background: Peritoneal dialysis (PD) is a widely employed renal replacement modality. A prospective study was conducted to determine the short-term and midterm outcomes and complication rates associated with a standardized optimal laparoscopic peritoneal dialysis catheter placement technique. Methods: All patients undergoing laparoscopic PD catheter placement by one surgeon using our standardized method over a 5-year period were entered into a prospective database. Patients were evaluated preoperatively and postoperatively through office visits. Development of complications was assessed using follow up telephone or mail surveys. Results: A total of 100 patients with a mean age of 56 years underwent laparoscopic PD catheter placement over the 5-year study period. In total, 103 laparoscopic PD catheter placement attempts were made in 100 patients. Placement was successful in 98 (95.1%) attempts and no placement required conversion to an open operation. Omentopexy was performed in 82 (83.7%) patients. There was no mortality reported within 30 days of the index operation. For patients who successfully underwent laparoscopic PD placement, early complications developed in 9 (9.2%) patients, of which 6 (6.1%) complications were directly related to the PD catheter. Midterm complications developed in 25 (25.5%) patients. Complication-related catheter repositioning was required for 12 (12.2%) catheters and catheter-related complication removal was required for 18 (18.4%) catheters. Conclusion: Laparoscopic placement of PD catheters can be successfully performed using a combination of described standardized laparoscopic maneuvers for optimal placement resulting in acceptable perioperative and short and midterm complication rates with negligible mortality rates.
Smith B; Mirhaidari S; Shoemaker A; Douglas D; Dan AG
JSLS-Journal Of The Society Of Laparoendoscopic Surgeons
2021
2021-01
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4293/JSLS.2020.00115" target="_blank" rel="noreferrer noopener">10.4293/JSLS.2020.00115</a>
The underrated role of ultrasound in peritoneal dialysis.
complication; diagnosis; infection; malfunction; peritoneal dialysis; ultrasound
Ultrasound is very effective in performing procedures and assessment of complications in peritoneal dialysis. The ultrasound examination can be applied for preoperative assessment, during the peritoneal catheter placement, for the detection and monitoring of infection, as well as for the evaluation of the catheter malfunction. Despite being not only a cost- and time-saving technique but also a bedside procedure, ultrasonography remains an underrated clinical tool in the field of peritoneal dialysis. This publication wants to explain and reinforce the clinical utility of US in PD and to expand the diagnostic equipment for the clinician.
Granata A; Rahbari E; Di Nicolò P; Battaglia Y; Campo I; Fresilli D; Pacini P; Lucatelli P; Barr RG; Cantisani V; Zeiler M
Journal Of Ultrasound In Medicine
2021
2021-03-29
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1002/jum.15710" target="_blank" rel="noreferrer noopener">10.1002/jum.15710</a>
Operative Technique for Laparoscopic Placement of Continuous Ambulatory Peritoneal Dialysis Catheter.
peritoneal dialysis; CAPD catheter placement; laparoscopic catheter placement; PD catheter placement
Background: Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. Objectives: To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Conclusion: Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.
Smith Brandon M; Dan Adrian G
Journal of laparoendoscopic & advanced surgical techniques. Part A
2020
2020-02
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1089/lap.2019.0750" target="_blank" rel="noreferrer noopener">10.1089/lap.2019.0750</a>