Renal replacement therapy in neonates with congenital heart disease.
BACKGROUND
The acute renal failure (ARF) incidence in pediatric cardiac surgery intensive care unit (ICU) ranges from 5 to 20% of patients. In particular, clinical features of neonatal ARF are mostly represented by fluid retention, anasarca and only slight creatinine increase; this is the reason why medical strategies to prevent and manage ARF have limited efficacy and early optimization of renal replacement therapy (RRT) plays a key role in the outcome of cardiopathic patients.


METHODS
Data on neonates admitted to our ICU were prospectively collected over a 6-month period and analysis of patients with ARF analyzed. Indications for RRT were oligoanuria (urine output less than 0.5 ml/kg/h for more than 4 h) and/or a need for additional ultrafiltration in edematous patients despite aggressive diuretic therapy.


RESULTS
Incidence of ARF and need for RRT were equivalent and occurred in 10% of admitted neonates. Eleven patients of 12 were treated by peritoneal dialysis (PD) as only RRT strategy. PD allowed ultrafiltration to range between 5 and 20 ml/h with a negative balance of up to 200 ml over 24 h. Creatinine clearance achieved by PD ranged from 2 to 10 ml/min/1.73 m2. We reported a 16% mortality in RRT patients.


CONCLUSIONS
PD is a safe and adequate strategy to support ARF in neonates with congenital heart disease. Fluid balance control is easily optimized by this therapy whereas solute control reaches acceptable levels.
Morelli
Stefano
S
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy.
Ricci
Zaccaria
Z
Di Chiara
Luca
L
Stazi
Giulia V
GV
Polito
Angelo
A
Vitale
Vincenzo
V
Giorni
Chiara
C
Iacoella
Claudia
C
Picardo
Sergio
S
D058186:Acute Kidney Injury / Q000209:etiology* / Q000628:therapy*; D001002:Anuria / Q000209:etiology; D003422:Critical Care / Q000379:methods; D006331:Heart Diseases / Q000150:complications* / Q000151:congenital*; D006801:Humans; D007231:Infant, Newborn; D007362:Intensive Care Units; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods*; D011446:Prospective Studies; D017582:Renal Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D014882:Water-Electrolyte Balance