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Kidney Week

Abstract: PO2014

Prenatal Nephrology Consultations and Neonatal Dialysis Survey

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Sanderson, Keia, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, United States
  • Shih, Vivian, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Warady, Bradley A., Children's Mercy Hospitals and Clinics, Kansas City, Missouri, United States
  • Claes, Donna J., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Little is known about pediatric nephrology (PN) prenatal consultations for congenital anomalies of the kidney & urinary tract (CAKUT) or possible initiation of kidney replacement therapy (KRT) in neonatal end stage kidney disease (N-ESKD). The aims were to evaluate PN practice patterns for prenatal counseling of fetal CAKUT & to describe criteria used by PN to offer KRT in N-ESKD.

Methods

A 35 question Qualtrics® survey was distributed via the North American Pediatric Renal Trials and Collaborative Studies email list between 1/1/2021-3/31/2021.

Results

39 of 108(36%) participating pediatric sites in the US & Canada responded. Median number of faculty (MDs, APPs, APRNS) per center was 7. Median chronic hemodialysis (HD) and peritoneal dialysis (PD) patients per center were 8 & 8,respectively. 38(97%) centers provide prenatal consultation for fetal CAKUT and KRT for N-ESKD. Of those 38 centers,71% report only a select number of non-trainee workforce members (median 2 per center) participate in prenatal consults. 47% of centers have either written/unwritten criteria for offering KRT in N-ESKD.The most common contraindications to KRT was parental refusal(61%;Table 1). The most common birth weight contraindication was <1500g(52%). 82% of centers reported <5 neonates with ESKD were started on KRT within the past year. 58% of centers use HD therapies as a bridge to PD in N-ESKD(Figure 1); 100% of centers report PD as the primary modality at discharge.

Conclusion

Many PN programs provide prenatal consultations for CAKUT diagnoses by a select group of non-trainee workforce members. Only 50% of centers use written/unwritten criteria for decisions about KRT initiation in N-ESKD. Further multi-center research regarding prenatal consultations and neonatal KRT outcomes is necessary to provide greater evidence based practice.

Table 1: Reported contraindications to dialysis initiation in neonates with ESKD amongst surveyed PN centers (n=38 centers)
Contraindications reported in > 50% of surveyed centersContraindications reported in 10-50% of surveyed centersContraindications reported in < 10% of surveyed centers
-Parent/Guardian choosing not to pursue dialysis (n=23; 61%)

-Born below a minimum birth weight (n=21; 55%)

-Surgeon indicates contraindication for dialysis access placement (n=21, 55%)
-Severe pulmonary disorder/respiratory disease (n=15; 39%)

-Severe/life threatening genetic abnormality (n=13; 34%)

-Severe neurologic impairment (n=7; 18%)

-Refractory hypotension (n=7; 18%)

-Severe/life threatening cardiac abnormality (n=7; 18%)
-Severe/life threatening liver abnormality (n=3; 8%)

-Other severe/life threatening abnormality not already listed (n=3; 8%)

-Other contraindication (n=3; 8%)

-Below a minimum gestational age (n=2; 5%)

-Disagreement between Nephrology and other services regarding the decision to initiate dialysis (n=1; 3%)