A Study of Acute Kidney Injury in Neonates and its Outcome following Peritoneal Dialysis

Background: Acute Kidney Injury (AKI) is a common clinical condition encountered in NICU. It presents with diminished urinary output and/or retention in elevation of serum urea and creatinine, alteration in ECF volume, electrolytes and acid base homeostasis1. Sepsis and asphyxia are most common causes2. Peritoneal dialysis is generally regarded as optimal treatment modality in neonates with AKI who do not respond to medical treatment. It is technically a simple treatment modality which is constantly performed in neonates hospitalized in NICUs3. Objectives: 1) To study etiological profile of AKI in neonates admitted in Neonatal Intensive Care Unit (NICU). 2) To study Outcome of AKI in neonates following Peritoneal dialysis in NICU. Methods: This prospective interventional study was done in our MR medical college Hospital from October 2018 to April 2020. This study included 32 neonates admitted in NICU diagnosed with acute kidney injury and considered for peritoneal dialysis were considered for this study. Clinical history was taken and relevant investigations were performed to determine cause of AKI and peritoneal dialysis was performed, outcomes and complications related to PD were analysed. Statistical analysis used: Descriptive and inferential statistical analysis has been carried out in the present study. The results were analysed by using SPSS version 20.0. Results on continuous measurements were presented on Mean?SD (Min-Max) and results on categorical measurements were presented in Frequency (Percentage). Inferential statistics like Mann-Whitney U test was used to check difference between two groups. Results: Out of 32 neonates with AKI, 53.1% were males and 46.9% were females. While a normal birth weight was observed in 40.6% cases, 59.4% had low birth weight. Frequency of oliguric kidney injury was 71.9% and non-oliguric was 28.1%. Sepsis (78.1%) was the most common cause and followed by dehydration fever (50.0%). On peritoneal dialysis, complete recovery seen in 78.1% and mortality in 21.9% of neonates. PD related complications was seen in 46.8% neonates, most common being hypokalemia (12.5%), difficult drainage due to catheter block (12.5%) followed by hypoglycemia (9.4%), Conclusion: Acute kidney injury in neonates and infants is not uncommon and needs frequent renal function monitoring. Sepsis, dehydration fever and birth asphyxia are common predisposing factors for AKI. Peritoneal dialysis is an effective route of renal replacement therapy in the neonatal period for management of metabolic disturbances as well as renal failure. Although major complications of the procedure are uncommon, these patients still have a high mortality rate due to serious nature of the underlying primary causes.