Acute Peritoneal Dialysis in Critical Preterm Infants: A Case Series and Review of the Literature

Background: Acute kidney injury (AKI) in critically ill neonates is usually of pre-renal origin and, often, pharmacological treatment is not sufficient for resolution, requiring kidney replacement therapy (KRT). Due to the small body size and the unavailability of adequate devices for these patients, peritoneal dialysis (PD) appears to be the most easily achievable procedure. However, guidelines for PD management are lacking in this population. Objective: We aimed to report a single-center experience with preterm infants who underwent PD, describing the technical issues and the outcomes, and to review the existing literature. Methods: This retrospective study included preterm infants undergoing PD because of AKI unresponsive to pharmacological treatment. Data were compared to those available in the current literature. Results: Neonatal outcomes of twelve preterm infants were reported. PD was started before the onset of anuria in two oliguric patients, while it was started within 60 h of anuria in four patients, and between 72 and 144 h of anuria in the remaining six patients. One oliguric patient and one who started PD after 60 h of anuria had a complete recovery of kidney function with normalization of diuresis and renal function parameters. The other infants did not achieve complete resolution of AKI. The mortality rate was 91.7%, and even one of the two infants who had recovered kidney function later died due to an infectious complication. Conclusions: Our experience with a limited sample size did not allow us to obtain definitive conclusions. Our data and the current literature suggested that the prognosis is still negative, with a high mortality rate. Further research is needed to develop guidelines to optimize the management of preterm infants with AKI.