Short-term survival of hyperammonemic neonates treated with dialysis

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 [mu]mol/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. Electronic supplementary material The online version of this article (doi:10.1007/s00467-014-2945-x) contains supplementary material, which is available to authorized users
Author(s): Stefano Picca[sup.1] , Carlo Dionisi-Vici[sup.2] , Andrea Bartuli[sup.3] , Tommaso De Palo[sup.4] , Francesco Papadia[sup.5] , Giovanni Montini[sup.6] , Marco Materassi[sup.7] , Maria Alice Donati[sup.8] , Enrico Verrina[sup.9] , [...]