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[Peritoneal dialysis following open heart surgery in children]
K Nakamura1, T Onitsuka, M Kuwahara
1Second Department of Surgery, Miyazaki Medical College, Miyazaki, Japan.
Insights
Peritoneal dialysis (PD) was used in 3.9% of children after open heart surgery. Early PD initiation was linked to better renal recovery, though long-term survival remained poor due to low cardiac output syndrome.
Area of Science:
- Pediatric Nephrology
- Pediatric Cardiac Surgery
- Renal Replacement Therapy
Context:
- Open heart surgery in children can lead to postoperative renal dysfunction.
- Peritoneal dialysis (PD) is a potential renal replacement therapy for pediatric patients.
- Understanding the outcomes of PD in this specific high-risk population is crucial.
Purpose:
- To evaluate the efficacy and outcomes of postoperative peritoneal dialysis in children undergoing open heart surgery.
- To identify factors associated with renal function recovery in these patients.
- To compare outcomes between patients who recovered renal function and those who did not.
Summary:
- 13 children (3.9%) required PD post-open heart surgery between 1982-1991.
- Seven patients (54%) recovered renal function; six (46%) survived long-term.
- Earlier PD initiation (1.2 days vs. 3.2 days) correlated with improved renal recovery, but all survivors died of low cardiac output syndrome.
Impact:
- This study highlights the potential benefit of early PD initiation for renal recovery in pediatric cardiac surgery patients.
- It underscores the significant challenges in long-term survival for this cohort, primarily due to cardiac complications.
- Findings suggest PD can be a viable, albeit insufficient, intervention for acute kidney injury in this population.
Abstract:
From 1982 to 1991, 13 (3.9%) of 336 children who underwent open heart surgery required peritoneal dialysis postoperatively, including 5 with transposition of the great arteries, 4 with tetralogy of Fallot, 2 with ventricular septal defect, 1 each with atrioventricular canal defects and total anomalous pulmonary venous connection. Patients ages ranged from 12 days to 4 years (mean, 1 year and 4 months). The infusion catheter was directed toward diaphragm from the right lower quadrant, and the drainage catheter was placed in the pelvis from the left upper quadrant. Dialysis solution was instilled and drained simultaneously. Seven children (54%) recovered renal function, with six (46%) longterm survivors. Differences between patients who did and did not recovered renal function (Group A and Group B respectively) were examined. No significant intergroup difference existed in age or weight. PD was initiated significantly sooner in Group B (1.2 +/- 0.8 days) than in Group A (3.2 +/- 1.9 days) (p < 0.05). The negative fluid balance was 88.0 +/- 31 mL/kg/day in Group A and 78.4 +/- 25.0 mL/kd/day (NS). BUN and serum creatinine concentrations were slightly elevated in both group, but were not significant different. Patients in Group A were dialyzed from 3 days to 21 days (mean 9.9 +/- 6.4 days), and patients in Group B were dialyzed from 1 day to 14 days (mean 5.3 +/- 5.2 days) (NS). The central venous pressure (CVP) in Group A decreased while blood pressure (BP) and renal perfusion pressure (RPP) increased following initiation of PD. CVP increased in Group B, while BP and RPP decreased. All patients died of low cardiac output syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)