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Peritoneal dialysis in infants and children after open heart surgery
Insights
Continuous peritoneal dialysis effectively treated acute renal failure in pediatric patients post-cardiac surgery. Most infants and children recovered normal kidney function after this intervention.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Cardiovascular Surgery
Background:
- Congenital cardiac malformations require surgical intervention, often involving cardiopulmonary bypass.
- Postoperative acute renal failure (ARF) is a significant complication in pediatric cardiac surgery patients.
- Standard treatments for ARF, including volume expansion and diuretics, were ineffective in this cohort.
Purpose of the Study:
- To evaluate the efficacy of continuous peritoneal dialysis (CPD) in managing postoperative acute renal failure with anuria in infants and children undergoing cardiac surgery.
- To assess the safety and outcomes of CPD in this vulnerable patient population.
Main Methods:
- A retrospective analysis of 418 pediatric patients who underwent cardiac surgery between 1975 and 1979.
- Fifteen patients developed ARF with anuria unresponsive to conventional therapies.
- CPD was initiated promptly, with patients remaining sedated, intubated, and on controlled ventilation during dialysis.
Main Results:
- Ten out of fifteen patients (67%) recovered normal renal function, evidenced by normal serum creatinine at discharge after a mean of 6 days of CPD.
- No dialysis-related complications were observed.
- Five patients with complex cardiac malformations experienced early mortality due to myocardial failure, with a mean dialysis duration of 3 days.
Conclusions:
- Continuous peritoneal dialysis is a safe and effective treatment for acute renal failure with anuria in pediatric patients following cardiopulmonary bypass.
- Early initiation of CPD can lead to favorable renal recovery in this high-risk group.
- Complex cardiac anatomy is associated with a poorer prognosis despite renal support.
Abstract:
Over a period of 5 years, 1975-1979, 418 infants and children were operated on for congenital cardiac malformations using cardiopulmonary bypass. Fifteen patients (4 with transposition, 4 with Fallot's tetralogy, 1 with pulmonary atresia and 6 with complex composite malformations) developed acute renal failure with anuria, which did not respond to volume load, afterload reduction, low dose dopamine, diuretics and controlled ventilation. Continuous peritoneal dialysis was started within a few hours of anuria. During dialysis the patients remained sedated, intubated and on controlled normocapnic ventilation. No complications occurred caused by the dialysis per se. Ten patients recovered and had normal serum creatinine when discharged from hospital (mean duration of dialysis: 6 days). Complex cardiac malformations were overrepresented in the 5 patients who died early in the postoperative period due to myocardial failure (mean duration of dialysis: 3 days).