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Am J Perinatol 2024; 41(S 01): e156-e162
DOI: 10.1055/a-1850-4429
Original Article

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

Keia R. Sanderson
1   Department of Medicine-Nephrology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
,
Weiwen V. Shih
2   Department of Pediatrics-Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
,
Bradley A. Warady
3   Division of Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
,
Donna J. Claes
4   Department of Pediatrics, Division of Nephrology and Hypertension, University of Cincinnati College of Medicine, Cincinnati, Ohio
› Author Affiliations
Funding Dr. Warady is supported by that National Institutes of Health, through Grant U01DK66143. Dr. Sanderson is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR002490 and Grant 2015213 from the Doris Duke Charitable Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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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.

Keywords

peritoneal dialysis - chronic peritoneal dialysis - chronic hemodialysis - pediatric ESKD - infants - neonates


Publication History

Received: 01 December 2021

Accepted: 06 May 2022

Accepted Manuscript online:
12 May 2022

Article published online:
10 June 2022

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