title: Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants.
abstract: BACKGROUND
  Acute kidney injury (AKI) is common in infants after cardiopulmonary bypass and is associated with poor outcomes. Peritoneal dialysis improves outcomes in adults with AKI after bypass, but pediatric data are limited. This retrospective case-matched study was conducted to determine if the practice of peritoneal dialysis catheter (PDC) placement during congenital heart surgery is associated with improved clinical outcomes in infants at high risk for AKI.
  
  
  METHODS
  Forty-two infants undergoing congenital heart surgery with planned PDC placement (PDC+) were age-matched to infants undergoing similar surgery without PDC placement (PDC-). Demographic, baseline and outcome data were compared. Our primary outcome was negative fluid balance on postoperative days 1 to 3. Secondary outcomes included time to negative fluid balance, time to extubation, frequency of electrolyte corrective medications, inotrope scores, and other clinical outcomes.
  
  
  RESULTS
  Baseline data did not differ between groups. The PDC+ group had a higher percentage of negative fluid balance on postoperative days 1 and 2 (57% vs 33%, P = .04; 85% vs 61%, P = .01). The PDC+ group had shorter time to negative fluid balance (16 vs 32 hours, P < .0001), earlier extubation (80 vs 104 hours, P = .02), improved inotrope scores (P = .04), and fewer electrolyte imbalances requiring correction (P = .03). PDC-related complications were rare.
  
  
  CONCLUSIONS
  PDC use is safe and associated with earlier negative fluid balance and improved clinical outcomes in infants at high risk for AKI. Routine PDC use should be considered for infants undergoing cardiopulmonary bypass. Further prospective studies are essential to prove causative effects of PDC placement in this population.
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: david.kwiatkowski@cchmc.org.
authors: David M
authors: DM
authors: Kwiatkowski
authors: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Shina
authors: S
authors: Menon
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Catherine D
authors: CD
authors: Krawczeski
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Stuart L
authors: SL
authors: Goldstein
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: David L S
authors: DL
authors: Morales
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Alistair
authors: A
authors: Phillips
authors: Division of Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Mo.
authors: Peter B
authors: PB
authors: Manning
authors: Division of Cardiothoracic Surgery, St Louis Children's Hospital, St Louis, Mo.
authors: Pirooz
authors: P
authors: Eghtesady
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: Yu
authors: Y
authors: Wang
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: David P
authors: DP
authors: Nelson
authors: Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors: David S
authors: DS
authors: Cooper
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002408:Catheters, Indwelling; D004867:Equipment Design; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*