title: Factors associated with survival in patients who undergo peritoneal dialysis catheter placement following cardiac surgery.
abstract: OBJECTIVE
  Pediatric post-cardiac surgery patients are at risk for acute kidney injury and intraabdominal hypertension. The present study assesses indications and outcomes of postoperative peritoneal dialysis catheter (PDC) placement in this population.
  
  
  METHODS
  We retrospectively reviewed single-institution patients who underwent PDC placement post-cardiac surgery between 1999 and 2011 (n=55). Baseline, clinical course, and outcome data were recorded pre- and post-PDC. We used multivariable logistic and Cox analyses to assess factors associated with mortality.
  
  
  RESULTS
  In-hospital mortality of the study cohort was 67.3% (n=37). Peritoneal dialysis was performed in 21 patients (38.2%). Five patients (9.1%) experienced adverse events related to PDC placement. Greater post-PDC decreases in abdominal girth (adjusted odds ratio [OR]=2.43; P=0.02) and BUN (OR=1.06; P=0.04) were associated with survival. Additionally, preoperative ventilator independence (hazard ratio [HR]=1.18; P<0.01) and lower creatinine (HR=8.32; P<0.01), as well as greater post-PDC decrease in inotrope score (HR=1.33; P<0.02) were associated with survival.
  
  
  CONCLUSIONS
  In-hospital mortality of the study cohort was 67%. Less severe pre-PDC renal impairment, increased pre-PDC abdominal girth, and greater post-PDC improvement of abdominal girth, renal function, and inotrope requirements were associated with survival. Prospective trials are needed to assess appropriate indications and timing of PDC placement, with consideration of more aggressive treatment for intraabdominal hypertension.
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Arin L
authors.initials: AL
authors.lastname: Madenci
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Stoffan
authors.forename: Satish K
authors.initials: SK
authors.lastname: Rajagopal
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Blinder
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Weldon
mesh_terms: D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D010530:Peritoneal Dialysis / Q000295:instrumentation* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Acute kidney injury; Cardiac surgical procedures; Catheters; Intraabdominal hypertension; Peritoneal dialysis; Renal insufficiency