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Outcomes of dialysis in neonates with anuric end-stage renal disease at birth: ethical considerations

Journal of Perinatology volume 42, pages 920–924 (2022)Cite this article

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Abstract

Introduction

We present a case series of neonates with anuric ESRD undergoing renal replacement therapy (RRT) and discuss the associated ethical implications of RRT in this population.

Methods

We reviewed patients who initiated RRT within 1 week of life due to anuric ESRD from 2009–2019 at a single tertiary center. Primary outcomes were receipt of renal transplant (RT), one-year survival, and overall survival.

Results

Five patients met the inclusion criteria. Two patients received an RT. One-year survival was 80%, while overall survival was 60% with a median follow-up of 18 months. In the 2 still-living patients who have not undergone RT, they are ineligible, one due to recent malignancy and the other from acquired cardiovascular comorbidities.

Conclusion

Patients with anuric ESRD requiring RRT undergo multiple treatment challenges with low RT and survival rates. These findings should be shared with families considering intervention for cases of severe renal disease diagnosed prenatally.

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Data availability

Data is not publicly available due to patient privacy laws but are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA

    Daniel S. Han

  2. Department of Pediatric Nephrology, Children’s Hospital Colorado, Aurora, CO, USA

    Margret E. Bock

  3. Department of Pediatrics and the Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Jacqueline J. Glover

  4. Department of Pediatric Urology, Children’s Hospital Colorado, Aurora, CO, USA

    Vijaya M. Vemulakonda

Authors
  1. Daniel S. Han
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  2. Margret E. Bock
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  3. Jacqueline J. Glover
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  4. Vijaya M. Vemulakonda
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Contributions

DSH: Substantial contributions to the design of the work, the acquisition, analysis, and interpretation of data, drafting of the work and critical revision. MEB: Substantial contributions to the conception and design of the work, the analysis and interpretation of data, drafting the work and critical revision. JJG: Substantial contributions to the conception and design of the work, drafting the work and critical revision. VMV: Substantial contributions to the conception and design of the work, the analysis and interpretation of data, drafting the work and critical revision. All authors approve of the final version to be published and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Daniel S. Han.

Ethics declarations

Statement of Ethics

Our study complied with the guidelines for human studies and was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. The study protocol was approved by our institutional review board (IRB) committee on human research, approval 19–1369. This study was granted exemption from requiring written informed consent by the University of Colorado, Anschutz IRB committee.

Competing interests

The authors declare no competing interests.

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Han, D.S., Bock, M.E., Glover, J.J. et al. Outcomes of dialysis in neonates with anuric end-stage renal disease at birth: ethical considerations. J Perinatol 42, 920–924 (2022). https://doi.org/10.1038/s41372-022-01328-2

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  • DOI: https://doi.org/10.1038/s41372-022-01328-2

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