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Early Peritoneal Dialysis and Major Adverse Events After Pediatric Cardiac Surgery: A Propensity Score Analysis
Siva P Namachivayam, Warwick Butt, Johnny Millar
1Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
Insights
Early peritoneal dialysis significantly reduces major adverse events in infants after pediatric cardiac surgery. This approach may improve outcomes for children with congenital heart disease, warranting further randomized trials.
Area of Science:
- Pediatric Cardiac Surgery
- Peritoneal Dialysis
- Cardiopulmonary Bypass
Background:
- Inflammatory responses post-cardiopulmonary bypass can impact outcomes in pediatric cardiac surgery patients.
- Early intervention strategies are being explored to mitigate adverse events in this vulnerable population.
Purpose of the Study:
- To evaluate the effect of early versus late peritoneal dialysis on major adverse events following pediatric cardiac surgery.
- To assess the impact of early peritoneal dialysis on key secondary outcomes, including ventilation duration and intensive care stay.
Main Methods:
- Observational study comparing infants receiving early (within 6 hours) vs. late peritoneal dialysis post-cardiac surgery.
- Propensity score methodology with inverse probability of treatment weighting was employed to control for selection bias.
- Primary outcome: composite of cardiac arrest, emergency reoperation, ECMO, or death; secondary outcomes: ventilation duration, ICU and hospital length of stay.
Main Results:
- Early peritoneal dialysis was associated with a significantly decreased risk of major adverse events (RR 0.16, p < 0.001).
- Patients receiving early peritoneal dialysis experienced shorter mechanical ventilation duration and intensive care unit stays.
- In infants with prolonged cardiopulmonary bypass (>150 minutes), early peritoneal dialysis demonstrated a survival advantage (RR 0.14, p = 0.03).
Conclusions:
- Early initiation of peritoneal dialysis following pediatric cardiac surgery is linked to a reduction in major adverse events.
- Findings suggest a potential benefit of early peritoneal dialysis in improving outcomes for infants undergoing cardiopulmonary bypass.
- Randomized trials are recommended to confirm these benefits and guide clinical practice, particularly for children with congenital heart disease.
Objectives:
Early peritoneal dialysis may have a role in modulating the inflammatory response after cardiopulmonary bypass. This study sought to test the effect of early peritoneal dialysis on major adverse events after pediatric cardiac surgery involving cardiopulmonary bypass.
Design:
In this observational study, the outcomes in infants post cardiac surgery who received early peritoneal dialysis (within 6 hr of completing cardiopulmonary bypass) were compared with those who received late peritoneal dialysis. The primary outcome was a composite of one or more of cardiac arrest, emergency chest reopening, requirement for extracorporeal membrane oxygenation, or death. Secondary outcomes included duration of mechanical ventilation, length of intensive care, and hospital stay. A propensity score methodology utilizing inverse probability of treatment weighting was used to minimize selection bias due to timing of peritoneal dialysis.
Setting:
Cardiac ICU, The Royal Children's Hospital, Melbourne, VIC, Australia.
Patients:
From 2012 to 2015, infants who were commenced on peritoneal dialysis after cardiac surgery were included.
Measurements And Main Results:
Among 239 eligible infants, 56 (23%) were commenced on early peritoneal dialysis and 183 (77%) on late peritoneal dialysis. At 90 days, early peritoneal dialysis as compared with late peritoneal dialysis was associated with a decreased risk of primary outcome (relative risk, 0.16; 95% CI, 0.05-0.47; p < 0.001 and absolute risk difference, -18.1%; 95% CI, -25.1 to -11.1; p < 0.001). Early peritoneal dialysis was also associated with a decrease in duration of mechanical ventilation and intensive care stay. Among infants with a cardiopulmonary bypass greater than 150 minutes, early peritoneal dialysis was also associated with a survival advantage (relative risk, 0.14; 95% CI, 0.03-0.84; p = 0.03 and absolute risk difference, -7.8; 95% CI, -13.6 to -2; p = 0.008).
Conclusions:
Early peritoneal dialysis in infants post cardiac surgery is associated with a decrease in the rate of major adverse events. The role of early peritoneal dialysis warrants the conduct of randomized trials both in high and low-to-middle income countries; any beneficial effects if confirmed have the potential to strongly influence outcomes for children born with congenital heart disease.
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