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Peritoneal dialysis following open heart surgery in children
J Hanson1, S Loftness, D Clarke
1Department of Cardiac Surgery, Children's Hospital of Denver, Denver, Colorado 80218.
Insights
Peritoneal dialysis is a safe and effective treatment for complex postoperative cardiac bypass patients, particularly infants. While younger age increases the need for dialysis, it does not predict mortality in treated patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Complex postoperative cardiac bypass surgery can lead to kidney complications.
- Infants and young children undergoing cardiac surgery are at higher risk for renal dysfunction.
Purpose of the Study:
- To evaluate the efficacy and safety of peritoneal dialysis in complex postoperative cardiac bypass cases.
- To identify predictors of mortality and the need for dialysis in this patient population.
Main Methods:
- Retrospective analysis of 338 complex postoperative cardiac bypass cases over 5 years.
- 26 patients (7.7%) received peritoneal dialysis for indications including oliguria, fluid overload, hyperkalemia, and anuria.
- Patient age, timing of dialysis initiation, duration, and outcomes were recorded.
Main Results:
- Peritoneal dialysis successfully treated the indications in all cases with no major complications.
- Low cardiac output was a significant predictor of death in dialysis patients (p=0.015).
- Younger age predicted the need for dialysis and mortality in the overall bypass population, but not mortality within the peritoneal dialysis group.
Conclusions:
- Peritoneal dialysis is a viable and safe option for managing renal complications post-cardiac bypass in complex pediatric cases.
- While younger age is associated with increased need for dialysis after cardiac surgery, it is not a predictor of mortality in those receiving peritoneal dialysis.
- Low cardiac output remains a critical factor influencing survival in these patients.
Abstract:
Over the course of the last 5 years, we have instituted peritoneal dialysis on 26 (7.7%) of 338 complex postoperative cardiac bypass cases. The mean age of dialysis patients was 0.64 +/- 0.75 years with a range of 0.1-2.5 years. The indications for the start of dialysis were oliguria (15 cases), fluid overload (three cases), hyperkalemia (one case), and anuria (seven cases). There were no complications as the result of dialysis, although two of the dialysis catheters had to be replaced. Dialysis successfully treated the starting indication in all cases. Dialysis was instituted at 47 +/- 50 (12-240) h after bypass, and lasted 111 +/- 134 (18-552) h; early institution of dialysis had no effect on mortality. Low cardiac output was a significant predictor of death in dialysis patients (p = 0.015). Age was a significant determinant of death (p = 0.0001) and the need for dialysis (p = 0.0043) in the total bypass population; the younger the patient, the greater was the likelihood of death or the need for dialysis. Age, however, was not a predictor of mortality in the peritoneal dialysis group.