For a study, researchers sought to evaluate the outcomes of newborns receiving renal replacement therapy (RRT) for hyperammonemia in a modern multi-institutional cohort.

They conducted a retrospective review of 51 newborn kids with verified inborn metabolic abnormalities who were treated at nine different children’s hospitals in the United States between 2000 and 2015.

About 29 patients (57%) underwent hemodialysis, 21 patients (41%) had continuous renal replacement treatment, and one patient received peritoneal dialysis (2%). The median age of survivors (n=33 [65%]) and nonsurvivors (n=18) at admission was 3 days. Upon admission, peak ammonia levels and ammonia levels did not differ substantially between survivors and nonsurvivors. Hemodialysis, having more than one rationale for RRT besides hyperammonemia, and problems during RRT were all risk factors for death. Hemodialysis was linked with a greater risk of mortality after accounting for several patient variables in the multivariable analysis compared to continuous renal replacement treatment. In a single Cox regression model with clinical factors such as evidence of renal dysfunction, a number of complications, concurrent extracorporeal membrane oxygenation, vasopressor requirement, and degree of hyperammonemia held constant, the hazard ratio for death with hemodialysis was 4.07 (95% CI 0.908-18.2, P value=.067). They developed a prediction model with input characteristics known at the start of RRT to enable doctors caring for newborns with hyperammonemia to estimate their patients’ chances of survival.

The use of continuous renal replacement treatment for newborn hyperammonemia is supported by the large, multicenter retrospective review.