title: Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality.
abstract: Acute kidney injury (AKI) is frequent in the postoperative period of pediatric heart surgery and leads to significant morbidity and mortality. Renal replacement therapies (RRTs) are often used to treat AKI; however, these therapies have also been associated with higher mortality rates. Earlier initiation of RRT might improve outcomes. This study aims to investigate the relationship between the RRT and morbidity and mortality after pediatric heart surgery. We performed a single-center retrospective study of all children undergoing pediatric heart surgery between April 2010 and December 2012 at a tertiary children's hospital. A total of 480 patients were included. Of those, 109 (23 %) were neonates and 126 patients (26 %) developed AKI within the first 72 postoperative hours. Patients who developed AKI had longer PICU admissions [12 days (4-37.75) vs. 4 (2-11); p < 0.001] and hospital length of stay [27 (11-53) vs. 14 (8-24) p < 0.001] and higher mortality [22/126 (17.5 %) vs. 13/354 (3.7 %); p < 0.001]. RRT techniques were used in 32 (6.6 %) patients [18/109 (16 %) neonates and 14/371 (3.8 %) infants and children; p < 0.01], with 25 (78 %) receiving peritoneal dialysis (PD) and 7 (22 %) continuous RRT (CRRT). Patients who received PD within the first 24 postoperative hours had lower mortality compared with those in whom PD was initiated later [4/16 (25 %) vs. 4/9 (44.4 %)]. Mortality among patients who received CRRT was 28.6 % (2/7). No deaths were reported in patients treated with CRRT within the first 24 postoperative hours. Postoperative AKI is associated with higher mortality in children undergoing cardiac surgery. Early initiation of RRT, both PD in neonates and CRRT in pediatric patients, might improve morbidity and mortality associated with AKI.
authors.affiliation: Cardiac Intensive Care Division, Department of Critical Care Medicine, Children Hospital of Pittsburgh, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA. joansdt@gmail.com.|Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain. joansdt@gmail.com.
authors.forename: Joan
authors.initials: J
authors.lastname: Sanchez-de-Toledo
authors.affiliation: Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Perez-Ortiz
authors.affiliation: Department of Neonatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Gil
authors.affiliation: Cardiac Intensive Care Division, Department of Critical Care Medicine, Children Hospital of Pittsburgh, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Baust
authors.affiliation: Department of Neonatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Marcos
authors.initials: M
authors.lastname: Linés-Palazón
authors.affiliation: Unit of Clinical Research Support, Vall d'Hebron Research Institut, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Perez-Hoyos
authors.affiliation: Department of Pediatric Cardiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Gran
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Raul F
authors.initials: RF
authors.lastname: Abella
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D013030:Spain; D013997:Time Factors
keywords: Acute kidney injury; Continuous renal replacement therapy; Pediatric heart surgery; Peritoneal dialysis; Renal replacement therapies