Department of Medicine-Nephrology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Department of Pediatrics-Nephrology, Children's Hospital Colorado, University of Colorado, Aurora, Colorado.
Am J Perinatol. 2024 May;41(S 01):e156-e162. doi: 10.1055/a-1850-4429. Epub 2022 May 12.
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.
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.
All but one responding center ( = 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.
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.
儿科肾脏病学对先天性肾和尿路异常（CAKUT）进行产前咨询，以及对新生儿终末期肾病（ESKD）开始肾脏替代治疗的标准尚未得到很好的描述。我们评估了儿科肾脏病学对产前 CAKUT 咨询和新生儿透析开始的方法。
2021 年 1 月至 3 月期间，通过北美儿科肾脏试验和协作研究电子邮件列表分发了一份包含 35 个问题的 Qualtrics 调查。39 个儿科肾脏病中心完成了调查。
除了一个（ = 38）提供产前 CAKUT 咨询和新生儿透析外，所有参与调查的中心均提供产前 CAKUT 咨询和新生儿透析，多学科参与情况差异很大。近一半（47%）的中心使用书面/非书面标准来提供新生儿透析。新生儿透析的最常见禁忌症是父母拒绝（61%）、外科医生放置通路的禁忌症（55%）和出生体重（BW）禁忌症（55%，最常见的 BW 禁忌症是 BW<1500g）。总体而言，79%的中心报告在过去一年中照顾了<5 名患有 ESKD 的新生儿，61%的中心在需要透析的新生儿中在腹膜透析前使用血液透析治疗，并且 100%的中心在出院时过渡到腹膜透析。
许多儿科肾脏病学计划提供产前 CAKUT 咨询和新生儿透析，但实践方法存在差异。需要进一步开展多中心研究，探讨产前咨询和新生儿透析结局，以进一步改善该人群的医疗服务。
