title: Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery.
abstract: BACKGROUND
  The development of renal dysfunction in the postoperative course of cardiac surgery is still associated with high mortality in pediatric patients. In particular for small infants peritoneal dialysis offers a secure and useful treatment option. The aim of the present study was to investigate if routinely used laboratory and clinical variables could help predict mortality at initiation of peritoneal dialysis.
  
  
  METHODS
  We performed a retrospective chart analysis of pediatric intensive care unit patients with renal dysfunction who were treated with peritoneal dialysis after cardiac surgery between 1993 and 2001 and analyzed variables obtained 3 hours or less before starting peritoneal dialysis.
  
  
  RESULTS
  Results are documented as means and standard errors. A total of 1141 children underwent a cardiac operation on cardiopulmonary bypass. Sixty-two children (5.4%) were treated with peritoneal dialysis. Mortality was 40.3% (37 survivors, 25 nonsurvivors). The pH in survivors was 7.35 (0.01); in nonsurvivors it was 7.23 (0.03; p = 0.0037). Base excess in survivors was -1.37 mmol/L (0.61); in nonsurvivors it was -7.17 mmol/L (1.49; p = 0.0026). Lactate in survivors was 4.5 mmol/L (0.60); in nonsurvivors it was 10.5 mmol/L (1.78; p = 0.0089). Positive inspiratory pressure in survivors was 24.6 cm H(2)O (0.78); in nonsurvivors it was 28.9 cm H(2)O (1.08; p = 0.0274). Tidal volume per kilogram bodyweight in survivors was 11.0 mL/kg (0.48); in nonsurvivors it was 8.7 mL/kg (0.50; p = 0.0493).
  
  
  CONCLUSIONS
  We conclude from our data that the consideration of pH, base excess, lactate, positive inspiratory pressure, and tidal volume per kilogram bodyweight help predict mortality at initiation of peritoneal dialysis. We were able to observe significant differences between survivors and nonsurvivors using these variables.
authors.affiliation: Department of Neonatology and Pediatric Intensive Care, University Children's Hospital of Vienna, Vienna, Austria. harald.boigner@akh-wien.ac.at
authors.forename: Harald
authors.initials: H
authors.lastname: Boigner
authors.forename: Werner
authors.initials: W
authors.lastname: Brannath
authors.forename: Michael
authors.initials: M
authors.lastname: Hermon
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Stoll
authors.forename: Gudrun
authors.initials: G
authors.lastname: Burda
authors.forename: Gerhard
authors.initials: G
authors.lastname: Trittenwein
authors.forename: Johann
authors.initials: J
authors.lastname: Golej
mesh_terms: D006348:Cardiac Surgical Procedures / Q000401:mortality*; D006801:Humans; D007223:Infant; D010530:Peritoneal Dialysis; D011379:Prognosis; D012189:Retrospective Studies