title: Use of peritoneal dialysis after surgery for congenital heart disease in children.
abstract: Acute kidney injury (AKI) is a common complication in children after surgery for congenital heart disease, and peritoneal dialysis (PD) is usually the renal replacement therapy (RRT) of choice, especially in very young children. The aim of the present study was to describe our experience of using PD to treat AKI after cardiac surgery. We retrospectively analyzed children 1 week to 16 years of age undergoing cardiac surgery during 2000-2008 and found the incidence of AKI treated with PD to be 2.3%. In the 23 patients treated with PD (13 male; average age: 29 ± 48.4 months; weight: 9.1 ± 8.1 kg), the indications for PD initiation were oliguria (n = 13), anuria (n = 9), and acidosis (n = 1). The average time between cardiac surgery and AKI was 4.8 ± 16.8 hours, and between AKI and PD initiation, it was 12 ± 16.8 hours. Patients were treated for a mean of 4.8 ± 3.8 days. Two patients developed peritonitis, and mechanical dysfunction of the PD catheter occurred in 1 patient. In-hospital mortality was 43.4%. Patients treated with PD weighed less (p = 0.004) and had longer bypass time (p = 0.004), inotrope use (p = 0.000), and mechanical ventilation (p = 0.000). However, in a regression analysis, only cardiopulmonary bypass time (odds ratio: 1.021; 95% confidence interval: 0.998 to 1.027; p = 0.032) remained predictive of a subsequent need for PD. We conclude that PD is an efficacious RRT for AKI in children undergoing cardiac surgery and that, in this setting, bypass time is the strongest predictor of a subsequent need for RRT.
authors.affiliation: Nephrology Department, Amato Lusitano Hospital, Castelo Branco, Portugal. santos9_cat@yahoo.com
authors.forename: Catarina R
authors.initials: CR
authors.lastname: Santos
authors.forename: Patrícia Q
authors.initials: PQ
authors.lastname: Branco
authors.forename: Augusta
authors.initials: A
authors.lastname: Gaspar
authors.forename: Margarida
authors.initials: M
authors.lastname: Bruges
authors.forename: Rui
authors.initials: R
authors.lastname: Anjos
authors.forename: Margarida S
authors.initials: MS
authors.lastname: Gonçalves
authors.forename: Miguel
authors.initials: M
authors.lastname: Abecasis
authors.forename: Carlos
authors.initials: C
authors.lastname: Meneses
authors.forename: José D
authors.initials: JD
authors.lastname: Barata
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010530:Peritoneal Dialysis; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies