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Published on: July 19, 2018
[Treatment of fluid overload and kidney failure with periotoneal dialysis after heart surgery]
B Gianoglio1, A Amore, R Bonaudo
1Divisione di Nefrologia, Divisione di Cardiochirurgia, Azienda Ospedaliera OIRM-S. Anna, Torino.
Insights
Early peritoneal dialysis in infants after cardiac surgery significantly reduced mortality and improved renal function. This approach helps manage fluid overload and acute kidney injury in high-risk pediatric patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Context:
- Infants undergoing cardiac surgery with prolonged cardiopulmonary bypass are at high risk for acute kidney injury due to renal hypoxia and low cardiac output.
- Fluid overload from oligo-anuria and low cardiac output is a significant complication in these patients.
Purpose:
- To evaluate the efficacy of an early peritoneal dialysis protocol in managing fluid overload and improving outcomes in infants following cardiac surgery.
- To assess the impact of early peritoneal dialysis on renal function and survival rates in this vulnerable pediatric population.
Summary:
- A protocol involving early peritoneal dialysis was implemented for 12 infants (median age 65.5 days) undergoing complex cardiac malformation repair with prolonged cardiopulmonary bypass.
- Automated peritoneal dialysis exchanges (10 ml/kg of 1.5% glucose) were initiated at the first signs of inadequate diuretic response or "leaky capillary syndrome."
- Infusional therapy included albumin, fresh frozen plasma, and furosemide to manage fluid shifts and edema.
Impact:
- The early peritoneal dialysis protocol resulted in a 30-day mortality rate of 25% (3/12), which is considerably lower than reported rates of 33-79% in similar patient cohorts.
- Renal function normalized in 8/12 patients by the end of the observation period, with 2 cases developing chronic renal failure.
- These findings suggest that early peritoneal dialysis may be a beneficial strategy to improve survival and renal outcomes in infants after cardiac surgery.
Background:
Infants undergoing cardiac surgery with prolonged cardio-pulmonary bypass are particularly exposed to the risk of acute renal failure for renal hypoxia due to low cardiac output.
Methods:
To limit fluid overload deriving from oligo-anuria and low cardiac output we have recently adopted an early peritoneal dialysis protocol, positioning the peritoneal catheter during the intervention and performing early exchanges at first signs of inadequate diuretic response and/or "leaky capillary syndrome" with diffuse edema. From 1-1 to 31-12-1997 12 patients (8 males), of median age of 65.5 days (range 1-350 days) and median weight of 3463 g (range 2380-6550 g) were treated with peritoneal dialysis (automated exchanges of 10 ml/kg body weight of 1.5% glucose, dwell time 20 minutes). Cardiac pathologies included complex hearth malformations. Cardiopulmonary bypass lasted a mean of 202 minutes (range 102-372 minutes). The children were treated for a minimum of 1 to 42 peritoneal dialysis sessions. The infusional therapy included human albumin and fresh frozen plasma to substitute losses and furosemide at the dose of 4 mg/kg/day to reduce the "leaky capillary syndrome".
Results:
The results were very satisfactory: only 3 children died in the first 30 days after surgery. Renal function was normal at the end of the observation in 8/12 cases, and 2 cases presented chronic renal failure.
Conclusions:
Since similar series report a mortality rate of 33-79%, it is suggested that early peritoneal dialysis may have positively influenced the final survival rate.
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