Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients.

Sarvesh Pal Singh,Yatin Arora,Manoj Kumar Sahu,V Devagouru,P Rajshekar,Bipin C,Shiv Kumar Chaudhary

doi:10.5005/jp-journals-10071-23221

Abstract

ABSTRACTBackgroundWe determined the prevalence of acute kidney injury requiring peritoneal dialysis (PD), the factors associated with early PD initiation, prolonged PD and mortality among pediatric postoperative cardiac surgical patients.Materials and MethodsThe hospital records of 23 children, aged 12 years or younger, who had undergone cardiac surgery and required PD subsequently, during a 1-year period were reviewed. Demographic data, intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors of PD, between the short and long duration PD groups, and between the early and late PD initiation groups.ResultsSix hundred and eight pediatric patients who underwent open heart surgery were enrolled in this study. 23 (3.78%) of them required PD. When compared with survivors (n = 11), non survivors (n =12) were more likely to have a higher serum procalcitonin (p = 0.01), higher serum potassium on day 2 (p = 0.001), day 3 (p = 0.04), day of termination of PD (p = 0.001) and a lower urine output on day 3 of PD (p = 0.03). Prolonged PD was associated with time of PD initiation (p = 0.01), a higher postoperative serum creatinine on day 3 (p = 0.01) of PD initiation as well on the day of PD termination (p = 0.01) and the final outcome in terms of survival (p = 0.02). Factors significantly associated with an early PD initiation were CPB time (p = 0.04), sepsis (p = 0.02) and shorter PD duration (p = 0.003).ConclusionPD is very useful mode of renal replacement therapy among pediatric postoperative cardiac surgical patients. The intraoperative and postoperative variables have important association with the time of PD initiation, PD duration and patient survival.How to cite this articleSahu MK, Bipin C, Arora Y, Singh SP, Devagouru V, Rajshekar P, et al. Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients. Indian J Crit Care Med 2019;23(8):371–375.

Highlights

Acute kidney injury (AKI) is a well-known complication which faces treatment challenges after pediatric cardiac surgery.[1–3] Risk factors of AKI and the need for renal replacement therapy include young age, complex cardiac lesions, long cardiopulmonary bypass time, and a low cardiac output state after surgery.[4–6] the choice of renal replacement therapy is controversial,[7,8] Peritoneal dialysis (PD) has been shown to be useful because of the ease of application, effectiveness in fluid removal and avoidance of additional vascular access and anticoagulation.[1–3,6–8] Many studies have documented the importance of young age as a determinant of AKI and peritoneal dialysis (PD) after pediatric cardiac surgery.[3–5] A retrospective analysis was performed in 23 young children aged 12 years or younger undergoing open heart surgery for congenital heart diseases
Many studies have documented the importance of young age as a determinant of AKI and PD after pediatric cardiac surgery.[3–5]
Short duration PD was associated with decreased mortality during the postoperative period (p=0.02)

Summary

Introduction

Acute kidney injury (AKI) is a well-known complication which faces treatment challenges after pediatric cardiac surgery.[1–3] Risk factors of AKI and the need for renal replacement therapy include young age, complex cardiac lesions, long cardiopulmonary bypass time, and a low cardiac output state after surgery.[4–6] the choice of renal replacement therapy is controversial,[7,8] Peritoneal dialysis (PD) has been shown to be useful because of the ease of application, effectiveness in fluid removal and avoidance of additional vascular access and anticoagulation.[1–3,6–8] Many studies have documented the importance of young age as a determinant of AKI and PD after pediatric cardiac surgery.[3–5] A retrospective analysis was performed in 23 young children aged 12 years or younger undergoing open heart surgery for congenital heart diseases. Acute kidney injury (AKI) is a well-known complication which faces treatment challenges after pediatric cardiac surgery.[1–3]. Risk factors of AKI and the need for renal replacement therapy include young age, complex cardiac lesions, long cardiopulmonary bypass time, and a low cardiac output state after surgery.[4–6]. The choice of renal replacement therapy is controversial,[7,8] Peritoneal dialysis (PD) has been shown to be useful because of the ease of application, effectiveness in fluid removal and avoidance of additional vascular access and anticoagulation.[1–3,6–8]. Many studies have documented the importance of young age as a determinant of AKI and PD after pediatric cardiac surgery.[3–5]. We determined the risk factors association with prolonged PD, early PD initiation and mortality. We determined the prevalence of acute kidney injury requiring peritoneal dialysis (PD), the factors associated with early PD initiation, prolonged PD and mortality among pediatric postoperative cardiac surgical patients

Results

Discussion

Conclusion