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Peritoneal dialysis in infants and children after open heart surgery
Jen-Chung Chien1, Be-Tau Hwang, Zen-Chung Weng
1Department of Pediatrics, Lo-Tung Pohai Hospital, Ilan, Taiwan.
Insights
Early peritoneal dialysis (PD) is effective for pediatric acute renal failure (ARF) after heart surgery. Shorter bypass times and earlier PD initiation improve survival in these high-risk patients.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Congenital heart disease repair in children carries a risk of renal dysfunction.
- Acute renal failure (ARF) is a serious complication in pediatric patients post-open heart surgery.
Purpose of the Study:
- To identify risk factors for prolonged peritoneal dialysis (PD).
- To determine mortality predictors in pediatric ARF patients requiring PD after open heart surgery.
Main Methods:
- Retrospective analysis of 542 children undergoing open heart surgery (June 1999-May 2007).
- Comparison of clinical and laboratory data between survivors and non-survivors among 7 ARF patients requiring PD.
- Analysis of cardiopulmonary bypass time, aortic clamping time, arterial blood gas, and PD timing/duration.
Main Results:
- Non-survivors had significantly longer cardiopulmonary bypass and aortic clamping times.
- Survivors exhibited higher arterial blood gas pH and base excess.
- Earlier initiation and shorter duration of PD were associated with survival.
Conclusions:
- Early PD intervention is safe and effective for pediatric ARF post-cardiac surgery.
- Cardiopulmonary bypass duration, aortic clamping time, timing and duration of PD, sepsis, and complications are prognostic indicators.
Background:
Infants and children who undergo surgical repair of complex congenital heart diseases are prone to developing renal dysfunction. The purpose of this study was to investigate the risk factors associated with prolonged peritoneal dialysis (PD) and the mortality of pediatric patients with acute renal failure (ARF) after open heart surgery.
Methods:
From June 1999 to May 2007, a total of 542 children underwent open heart surgery for congenital heart disease. Fifteen (2.8%) experienced ARF and seven (1.3%) required PD. The clinical and laboratory variables were compared between the survivor and non-survivor groups of ARF patients that needed PD.
Results:
The non-survivors (n=3, 43%) had a Longer cardiopulmonary bypass time (154+/-21 vs. 111+/-8 minutes, p=0.012) and longer aorta clamping time (92+/-40 vs. 66+/-15 minutes, p=0.010) than the survivors (n=4, 57%). Before the PD, the pH and base excess of the arterial blood gas analysis in the survivors was much higher than that non-survivors (7.30+/-0.04 vs. 7.16+/-0.10, p=0.039; -5.15+/-3.13 vs. -12.07+/-2.9mmol/L, p=0.031). Furthermore, the survivors had a shorter interval between the onset of ARF and the day the PD was begun (1.2+/-0.4 vs. 4.3+/-1.2 days, p=0.001), and shorter duration of PD (6.6+/-2.7 vs. 13.0+/-3.5 days, p=0.036) than non-survivors.
Conclusion:
Early intervention with PD is a safe and effective method for managing patients with ARF after open heart surgery. The cardiopulmonary bypass and aortic clamping duration, time of initiating PD, duration of the PD, sepsis, and relative complications may predict the prognosis of these patients.
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