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- Title
Assessment of fluid status in neonatal dialysis: the need for new tools.
- Authors
Nourbakhsh, Noureddin; Benador, Nadine
- Abstract
Background: Assessment of fluid status in neonatal dialysis has largely focused on traditional tools including clinical assessment, serial weights, and blood pressure (BP) measurements. However, in infants on kidney replacement therapy, the assessment of fluid overload is problematic due to errors in weight assessment, subtlety of physical exam findings, and inaccuracy of non-invasive BP measurements. Case summary: In this presentation of a neonate with bilateral renal agenesis requiring kidney replacement therapy, the treating team assessed a number of variables in determining the ultrafiltration prescription for dialysis across 2 modalities (hemodialysis and continuous kidney replacement therapy). Complications: Fluid overload, cardiomegaly, and worsened respiratory status occurred when attempting to assess the neonate's fluid status by traditional markers (weights, blood pressures, physical exam findings). B-type natriuretic peptide (BNP) was obtained and was noted to correlate with the degree of fluid overload. Key management points: Compared to traditional tools for assessment of fluid status in pediatric dialysis, BNP assisted the medical team in optimizing the volume status of the subject and determining optimal daily ultrafiltration goals. Due to the rapid release in response to myocardial stretch and the lack of kidney clearance of the peptide, BNP may represent an objective, timely, and reliable index of volume status in the pediatric dialysis patient.
- Subjects
THERAPEUTICS; BLOOD pressure; PHYSICAL diagnosis; HYPERVOLEMIA; BODY weight; WATER-electrolyte balance (Physiology); CARDIAC hypertrophy; EVALUATION; RENAL replacement therapy; ULTRAFILTRATION; REGULATION of body fluids; HEMODIALYSIS; PEPTIDE hormones
- Publication
Pediatric Nephrology, 2023, Vol 38, Issue 4, p1373
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-022-05829-2