Until recently, the standard treatment for newborns with kidney disease, whether caused by congenital anomaly or acute injury after birth, has been kidney dialysis, a complex intervention that too often has not prolonged life.

“Kidney dialysis machines are designed for adults; they use large catheters and require blood volumes that can be half or more of a newborn’s entire blood volume,” says Eileen Ciccia, MD, Washington University pediatric nephrologist at St. Louis Children’s Hospital. To address this problem, Ciccia says, “we sometimes used a transfusion of blood to increase the baby’s volume of blood, but that came with a risk of placing too much stress on a baby’s heart. It also meant exposing the infant to other people’s blood each time we used dialysis.”

Now, thanks to a creative adaptation of existing technology, a new option has significantly improved survival rates for newborns with kidney disease or injury from almost 0% to approximately 30%.

The machine that has been adapted for use in newborns typically is used to treat adults with fluid overload in a process called aquapheresis—the removal of excess salt and water from the body. This technology requires lower blood volumes than a standard dialysis machine, meaning less risk for newborns. In 2020, the Women & Infants Center at Barnes-Jewish Hospital, Washington University Physicians and St. Louis Children’s Hospital established a modified aquapheresis therapy program using this technology to provide kidney dialysis for infants. It is, to date, the only center of its kind in the St. Louis area offering this specialized treatment.

“This therapy represents a significant medical advancement because it allows us to provide treatment to babies weighing as little as four pounds,” says Melissa Riley, MD, Washington University specialist in the newborn intensive care unit at the Women & Infants Center. “Babies with conditions including fluid overload due to infection or oxygen deprivation at birth are placed on dialysis using this modified therapy for six to eight hours each day, which allows time for other therapies or interventions to be completed. Babies born with chronic kidney disease may be placed on dialysis for continuous, 24/7 rental replacement therapy.”

For newborns that incur kidney injury after birth, modified aquapheresis therapy may be the only treatment they need until their kidneys regain function. For newborns needing more time to heal, or for those with developmental abnormalities resulting in little or no kidney function, the therapy may be used as a bridge to further treatment.

“Our ultimate goal is to place these newborns on peritoneal dialysis,” Ciccia says. Instead of relying on the kidneys to filter blood, peritoneal dialysis uses the lining of the abdomen, called the peritoneum, as a filter. Ciccia explains that, for peritoneal dialysis, a catheter is inserted in the baby’s belly. “The incision to insert the catheter takes about two weeks to heal, and our modified aquapheresis therapy performs dialysis until healing is complete.” At that point, aquapheresis, which must be done in the hospital, can be replaced with peritoneal dialysis, which can be performed at home. “Modified aquapheresis allows us to get newborns home as quickly and as safely as possible,” Ciccia adds.

Riley notes that she and colleagues at the Women & Infants Center work closely with families, explaining treatment options and plans, and offering education about an infant’s condition and training for at-home care. “It’s a team effort,” she says, noting that a range of specialists, from neonatologists to maternal-fetal medicine specialists, are involved in caring for newborns diagnosed prenatally with kidney disease or who suffered a kidney injury after birth. Thanks to modified aquapheresis therapy, Ciccia adds, “we can offer new hope to parents.