LAUSR

BACKGROUND Pediatric nephrology prenatal consultations for congenital anomalies of the kidney and urinary tract (CAKUT) and criteria for kidney replacement therapy initiation in neonatal end-stage kidney disease (ESKD) are not well described. We evaluated pediatric nephrology approaches to prenatal CAKUT counseling and neonatal dialysis initiation. METHODS A 35 question Qualtrics® survey was distributed via the North American Pediatric Renal Trials and Collaborative Studies email list between January-March 2021. Thirty-nine pediatric nephrology centers completed the survey. RESULTS All but one responding center (n=38) provide prenatal CAKUT consultations and neonatal dialysis, with wide variability in reported multi-specialty involvement. Nearly half (47%) of centers utilize written/unwritten criteria for offering neonatal dialysis. The most common contraindications to neonatal dialysis were parental refusal (61%), contraindication to access placement by surgeons (55%), and birth weight (BW) contraindication (55%, with <1500g being the most common BW contraindication). Overall, 79% of centers reported caring for <5 neonates with ESKD in the past year, 61% use hemodialysis therapies prior to peritoneal dialysis in neonates requiring dialysis, and 100% transition to peritoneal dialysis by hospital discharge. CONCLUSION Many pediatric nephrology programs provide prenatal CAKUT consultations and neonatal dialysis, but with variability in practice approach. Further multi-center research regarding prenatal consultations and neonatal dialysis outcomes is necessary to further improve care delivery to this population.