Sequential Amnioinfusion Protocol for Treating Fetal Renal Failure: Impact on Survival and Transition to Renal Transplantation.

Abstract

Introduction: Fetal renal failure (FRF) is a challenging antenatal diagnosis associated with insufficient pulmonary development and potential compromise for the future possibility of dialysis and kidney transplantation. Even in cases in which lung development can be fostered by serial amnioinfusions (AIs), infants who are born prematurely may not qualify for peritoneal dialysis due to weight criteria.

Methods: We describe our outcomes after introducing an integrated approach at two institutions to prenatal management of FRF with a serial AI protocol and postnatal management with peritoneal dialysis. Our primary endpoint was survival to 6 months of age with successful dialysis, and the secondary outcomes included the ability to transition to renal transplantation.

Results: The mean gestational age at which AIs were initiated was 23.3 ± 2.32 weeks for the whole cohort. There was no significant difference between survivors (22.51 ± 1.70 weeks) and non-survivors (23.31 ± 2.69 weeks, p = 0.339) in the gestational age at initiation of AIs. The mean gestational age at delivery for the entire cohort was 34.8 ± 2.62 weeks, and there was a trend toward but did not achieve significance between survivors (35.0 ± 1.60 weeks) compared to non-survivors (33.17 ± 3.34 weeks, p = 0.066). Survival to delivery was 100% for the total AI cohort (n = 30).

Conclusion: A total of 83% of patients alive at 48 h survived the neonatal period and of those surviving the neonatal period, 62.5% survived a minimum of 6 months on outpatient peritoneal dialysis (PD). This series also established that PD can be successfully performed in neonates as small as 1,500 g. Four patients have successfully undergone renal transplantation. Serial AIs for FRF offer the potential, not only in neonatal pulmonary survival but also long-term survival to kidney transplantation.