Dialysis modality and mortality of the Contemporary Infant and Neonatal Dialysis (COINED) Cohort: a Pediatric Nephrology Research Consortium (PNRC) study
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Recent technologic advances in neonatal dialysis have changed current dialysis practices. The goal of this study was to define demographics, diagnoses, initial dialysis modality, modality changes, and outcomes of neonates receiving dialysis. METHODS: Retrospective, multicenter cohort of neonates (≤ 30 days of age) from 26 U.S. centers, who received dialysis between 6/2017 and 5/2022. Measures of central tendency were calculated to describe the cohort stratified by the primary dialysis-related diagnosis including acute kidney injury requiring dialysis (AKI-D), stage 5 chronic kidney disease (CKD 5), hyperammonemia, and other causes. The primary outcome was death during the initial hospitalization. RESULTS: For the 405 neonates in this cohort, AKI-D (57%) was the most common dialysis-related diagnosis, followed by CKD 5 (29%) and hyperammonemia (11%). Most neonates (58%) had a birth weight between 2500 and 3500 g. The most common initial neonatal dialysis modality was continuous kidney replacement therapy (CKRT) with (35%) or without extracorporeal membrane oxygenation (ECMO) (36%). Only 26% of neonates received peritoneal dialysis (PD) as their initial dialysis modality. Thirty percent of neonates received more than one dialysis modality. The overall mortality was 50% (59% in AKI-D and 41% in CKD 5). Withdrawal of care was reported as the most common reason for death. The odds of death were lower for neonates with AKI-D receiving PD as the initial modality when compared to CKRT (aOR 0.28, 95% CI 0.09-0.84) or CKRT with ECMO (aOR 0.24, 95% CI 0.10-0.58), but this association was not seen in neonates with CKD 5. CONCLUSIONS: This multicenter, contemporary neonatal dialysis cohort shows increased use of CKRT as the initial dialysis modality but also shows that the mortality of neonates on dialysis remains high. Additional studies on modern neonatal dialysis are needed.
Source: Pediatric Nephrology
Authors: Melissa Muff-Luett, Tennille Webb, Rebecca Scobell, Neha Pottanat, Eileen Ciccia, Donna Claes, Caitlin Carter, Sarah Nelson-Taylor, Morgan Beebe, Meredith Harris, Issa Alhamoud, Catherine Joseph, Matt Grinsell, Yonique Petgrave, Marc B. Lande, Kelsey Richardson, Bakri Alzarka, Randa Razzouk, Kim Piburn, Rushelle Byfield, Hannah Kim, Chryso Pefkaros Katsoufis, Clare Lindner, Brendan Crawford, Leonela Villegas, Robin High, Elizabeth Lyden, Keia Sanderson
Institutions: University of Nebraska Medical Center, Children's of Alabama, University of Alabama at Birmingham, Children's Hospital of Philadelphia, Riley Hospital for Children, Indiana University Indianapolis, Indiana University School of Medicine, Washington University in St. Louis, Cincinnati Children's Hospital Medical Center, University of Cincinnati, University of California San Diego, Rady Children's Hospital-San Diego, Children's Hospital Colorado, University of Colorado Anschutz, Nationwide Children's Hospital, Lurie Children's Hospital, University of Iowa, University of Iowa Stead Family Children’s Hospital, Baylor College of Medicine, Texas Children's Hospital, University of Utah, University of Tennessee Health Science Center, University of Rochester Medicine, University of Rochester, Oregon Health & Science University, University of Maryland, Baltimore, Cook Children's Medical Center, The University of Texas at San Antonio Health Science Center, Morgan Stanley Children's Hospital, Columbia University, Pennsylvania State University, Weill Cornell Medicine, University of Miami, University of Miami Hospital, University of Michigan, C. S. Mott Children's Hospital, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Connecticut Children's Medical Center, University of North Carolina at Chapel Hill
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,337
OpenAlex ID: W7123344926