Severe Fetal CAKUT (Congenital Anomalies of the Kidneys and Urinary Tract), Prenatal Consultations, and Initiation of Neonatal Dialysis.

Document Type

Article

Publication Date

5-2024

Identifier

DOI: 10.1055/a-1850-4429; PMCID: PMC9734282

Abstract

INTRODUCTION:  Pediatric nephrology prenatal consultations for congenital anomalies of the kidney and urinary tract (CAKUT) and criteria for kidney replacement therapy initiation in neonatal end-stage kidney disease (ESKD) are not well described. We evaluated pediatric nephrology approaches to prenatal CAKUT counseling and neonatal dialysis initiation.

METHODS:  A 35-question Qualtrics survey was distributed via the North American Pediatric Renal Trials and Collaborative Studies email list between January and March 2021. Thirty-nine pediatric nephrology centers completed the survey.

RESULTS:  All but one responding center (n = 38) provide prenatal CAKUT consultations and neonatal dialysis, with wide variability in reported multispecialty involvement. Nearly half (47%) of centers utilize written/unwritten criteria for offering neonatal dialysis. The most common contraindications to neonatal dialysis were parental refusal (61%), contraindication to access placement by surgeons (55%), and birth weight (BW) contraindication (55%, with < 1,500 g being the most common BW contraindication). Overall, 79% of centers reported caring for < 5 neonates with ESKD in the past year, 61% use hemodialysis therapies prior to peritoneal dialysis in neonates requiring dialysis, and 100% transition to peritoneal dialysis by hospital discharge.

CONCLUSION:  Many pediatric nephrology programs provide prenatal CAKUT consultations and neonatal dialysis, but with variability in practice approach. Further multicenter research regarding prenatal consultations and neonatal dialysis outcomes is necessary to further improve care delivery to this population.

Journal Title

American journal of perinatology

Volume

41

Issue

S 01

First Page

156

Last Page

162

MeSH Keywords

Humans; Infant, Newborn; Female; Urogenital Abnormalities; Pregnancy; Renal Dialysis; Kidney Failure, Chronic; Referral and Consultation; Surveys and Questionnaires; Nephrology; Urinary Tract; Vesico-Ureteral Reflux

Keywords

Urogenital Abnormalities; Pregnancy; Renal Dialysis; Chronic Kidney Failure; Referral and Consultation; Surveys and Questionnaires; Nephrology; Urinary Tract; Vesico-Ureteral Reflux

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