ESPN 54th Annual Meeting

ESPN 2022


 
First experience of continuous flow peritoneal dialysis in neonates with hyperammonemia due to inborn errors of metabolism.
Hai Liang Tan 1 Ming Jie Chuah 1 Jia Yi Tham 1 Elaine Ee Lane Wong 1 Chee Lee Chan 1 Lilian Ping Ling Ngo 2 Azie Jumaatul Adawiyah Nabir 2 Zuraidah Hj Abd Latif 2 Yok Chin Yap 1

1- DEPARTMENT OF PAEDIATRIC, HOSPITAL TUNKU AZIZAH, WOMEN AND CHILDREN HOSPITAL KUALA LUMPUR, MALAYSIA
2- DEPARTMENT OF PAEDIATRIC, HOSPITAL AMPANG, MALAYSIA
 
Introduction:

The prognosis of neurological outcome in hyperammonemia caused by inborn errors of metabolism (IEM) depends on plasma ammonia levels and duration of hyperammonaemic coma. Current guidelines suggest the use of continuous renal replacement therapy (CRRT) in the treatment of refractory hyperammonemia. Due to limited vascular access available in a newborn, conventional peritoneal dialysis (PD) has been studied but showed limited efficacy in reducing ammonia levels. This study aims to evaluate if continuous flow peritoneal dialysis (CFPD) is an effective treatment in the management of hyperammonemia due to IEM in newborns.  

Material and methods:

Three neonates were managed with CFPD in addition to standard medical therapy. CFPD was performed with two bedside-placed catheters sized 10F for inflow and 12F for outflow. The peritoneum was initially filled with 20ml/kg of dialysate during catheter insertion followed by continuous dialysate inflow with the use of an infusion pump at initial rate of 10ml/kg/hour then titrated up as tolerated. The dialysate outflow was gravity dependent with the drainage bag placed 80cm below the outflow catheter. Dialysate was bicarbonate buffered with 2% dextrose concentration. Infusion of dialysate was stopped every 4th hour to allow passive drainage.

Results:

The mean age of the patients were 9.3 ± 6.7 days old. The mean plasma ammonia level before dialysis was 1256 ± 466 µmol/L. The mean inflow rate of dialysate was 54 ± 19.9 ml/kg/hour. The mean outflow rate was 51.5 ± 22.9 ml/kg/hour. Plasma ammonia levels below the critical level of 200 µmol/L were achieved within 18 ± 2.6 hours. There were no peritonitis episodes or increased ventilatory support requirements. Minor complications were hypokalaemia that was corrected intravenously and one episode of blocked catheter, solved by switching the inflow and outflow catheter. All patients survived and were discharged home. 

Conclusions:

 This first report of using CFPD for the management of hyperammonemia due to IEM shows that it is effective in removing ammonia rapidly and safely.