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Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality

Joan Sanchez-de-Toledo1,2, Alba Perez-Ortiz3, Laura Gil4

  • 1Cardiac Intensive Care Division, Department of Critical Care Medicine, Children Hospital of Pittsburgh, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. joansdt@gmail.com.

Pediatric Cardiology
|December 22, 2015
PubMed

Insights

Early renal replacement therapy (RRT) may improve outcomes for pediatric heart surgery patients with acute kidney injury (AKI). Prompt RRT initiation, including peritoneal dialysis for neonates and continuous RRT for children, is linked to reduced morbidity and mortality.

Area of Science:

  • Pediatric Cardiology
  • Nephrology
  • Critical Care Medicine

Background:

  • Acute kidney injury (AKI) is a common and serious complication following pediatric heart surgery, significantly increasing morbidity and mortality.
  • While renal replacement therapies (RRTs) are used to manage AKI, their effectiveness and optimal timing remain areas of investigation.
  • Previous studies suggest that earlier intervention with RRT might lead to better patient outcomes.

Purpose of the Study:

  • To investigate the association between the timing of RRT initiation and patient outcomes, specifically morbidity and mortality, in children undergoing heart surgery.
  • To compare the outcomes of different RRT modalities, including peritoneal dialysis (PD) and continuous RRT (CRRT), in the context of postoperative AKI.
  • To determine if early RRT administration impacts survival rates in neonates and pediatric patients with AKI post-cardiac surgery.

Main Methods:

  • A single-center retrospective study was conducted, analyzing data from 480 children who underwent heart surgery between April 2010 and December 2012.
  • Patients developing AKI within 72 hours post-surgery were identified, and their RRT use, timing, and outcomes were recorded.
  • Statistical analysis compared outcomes between patients who received RRT and those who did not, and also analyzed the impact of early versus late RRT initiation.

Main Results:

  • Of 480 patients, 126 (26%) developed AKI, experiencing longer PICU admissions, hospital stays, and significantly higher mortality rates (17.5% vs. 3.7%).
  • RRT was used in 32 patients (6.6%), with PD in 25 and CRRT in 7. Neonates comprised a higher proportion of RRT recipients (16%).
  • Early PD initiation (within 24 hours) in neonates was associated with lower mortality (25% vs. 44.4%). No deaths occurred in pediatric patients receiving CRRT within 24 hours.

Conclusions:

  • Postoperative AKI is a critical factor contributing to increased mortality in pediatric cardiac surgery patients.
  • Early initiation of RRT, specifically PD for neonates and CRRT for pediatric patients, appears to be associated with improved survival.
  • Further research into optimizing RRT timing and strategies for AKI management in this vulnerable population is warranted.

Keywords:
Acute kidney injuryContinuous renal replacement therapyPediatric heart surgeryPeritoneal dialysisRenal replacement therapies

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