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- Title
Short-term survival of hyperammonemic neonates treated with dialysis.
- Authors
Picca, Stefano; Dionisi-Vici, Carlo; Bartuli, Andrea; De Palo, Tommaso; Papadia, Francesco; Montini, Giovanni; Materassi, Marco; Donati, Maria; Verrina, Enrico; Schiaffino, Maria; Pecoraro, Carmine; Iaccarino, Emilia; Vidal, Enrico; Burlina, Alberto; Emma, Francesco
- Abstract
Background: In severe neonatal hyperammonemia, extracorporeal dialysis (ECD) provides higher ammonium clearance than peritoneal dialysis (PD). However, there are limited outcome data in relation to dialysis modality. Methods: Data from infants with hyperammonemia secondary to inborn errors of metabolism (IEM) treated with dialysis were collected in six Italian centers and retrospectively analyzed. Results: Forty-five neonates born between 1990 and 2011 were enrolled in the study. Of these, 23 were treated with PD and 22 with ECD (14 with continuous venovenous hemodialysis [CVVHD], 5 with continuous arteriovenous hemodialysis [CAVHD], 3 with hemodialysis [HD]). Patients treated with PD experienced a shorter duration of predialysis coma, while those treated with HD had a shorter ammonium decay time compared with all the other patients ( p < 0.05). No difference in ammonium reduction rate was observed between patients treated with PD, CAVHD or CVVHD. Carbamoyl phosphate synthetase deficiency (CPS) was significantly associated with increased risk of death (OR: 9.37 [1.52-57.6], p = 0.016). Predialysis ammonium levels were significantly associated with a composite end-point of death or neurological sequelae (adjusted OR: 1.13 [1.02-1.27] per 100 μmol/l, p = 0.026). No association was found between outcome and dialysis modality. Conclusions: In this study, a delayed ECD treatment was not superior to PD in improving the short-term outcome of neonates with hyperammonemia secondary to IEM.
- Subjects
ITALY; METABOLIC disorder treatment; AMMONIA; APGAR score; CONFIDENCE intervals; CONTINUOUS arteriovenous hemofiltration; FISHER exact test; HEMODIALYSIS; MEDICAL cooperation; INBORN errors of metabolism; PERITONEAL dialysis; RESEARCH; SURVIVAL analysis (Biometry); SURVIVAL; T-test (Statistics); RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics; ODDS ratio; MANN Whitney U Test; DISEASE complications; CHILDREN
- Publication
Pediatric Nephrology, 2015, Vol 30, Issue 5, p839
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-014-2945-x