Evolution of the Management of AKI in Neonates

We in Vicenza began studies on buffers in peritoneal dialysis (PD), leading the pathway toward the use of bicarbonate in fluids (1–3). We analyzed the pathophysiologic pathways of neurotransmission, measuring several substances in the cerebrospinal fluid before and after dialysis (4, 5). In those days, the pressure to shorten hemodialysis treatments provided the impetus for studies on dialysis tolerance. We therefore focused on developing technology to make short dialysis efficient and safe (6). We studied fluid mechanics and flow distribution in dialyzers and mechanisms of solute transport in hollow fibers, and we applied all of this information to support rapid hemodialysis (7) and continuous arteriovenous hemofiltration (CAVH) (8). We developed new filters (9), described the adsorption process onto the membrane, and made the first filters with two ports in the filtrate compartment so that we could perform the first hemodiafiltration treatment (10). At the same time, we developed new fluid balance devices to be applied in intensive care patients (11).