Acute renal failure complicating pediatric cardiac surgery: A comparison of survivors and nonsurvivors following acute peritoneal dialysis

Abstract

The outlook for patients with cardiac surgery complicated by acute renal failure (ARF) is poor, with a reported mortality of 50-67%. In addition to assessing the impact of recent advances in pediatric cardiac surgery on the mortality rate and renal outcome of surgery complicated by ARF requiring peritoneal dialysis (PD), this study compares preoperative, operative, and postoperative variables in patients who survived surgery and those who did not survive. From 1982 through 1988, 44 postoperative cardiac patients developed ARF, and 40 (age: 2 days to 15 years) required PD. Seventeen of 40 patients survived (mortality 57.5%) and 16 of these patients recovered normal renal function. Preoperative variables, including operative age and weight, did not appear to directly influence survival. Operative profiles, including length of cardiopulmonary bypass, aortic cross-clamp time, and hypotension immediately off bypass, did not distinguish surviving patients from those that did not survive. Postoperative variables, such as postoperative hypotension treatment, arrhythmias, hematologic status, cardiac arrest with resuscitation, did not differentiate survivors from nonsurvivors. The mean duration of PD was less than 2 weeks, and complications were infrequent. Renal status following PD in survivors was usually normal. We conclude that recent advances in pediatric cardiac surgery have not further increased the high mortality of surgery complicated by ARF. Survival is associated with renal recovery and thus aggressive treatment using PD is warranted.

Predictors of acute kidney injury post-cardiopulmonary bypass in children

“…Despite improvements in surgical procedures and intra-and postoperative supportive care for children operated on for congenital heart disease, mortality due to postoperative complications and multiorgan dysfunction including AKI remains high [12][13][14][15]. Complexity of the underlying heart disease and surgical procedure [e.g.…”

Adequacy of peritoneal dialysis in children following cardiopulmonary bypass surgery

“…Acute renal failure (ARF) requiring renal replacement therapy occurs in up to 5% of children undergoing cardiopulmonary bypass (CPB) [1,2,3,4,5,6,7,8,9,10,11,12] and is associated with an increased mortality rate of 20-79% [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. Perioperative resuscitation and low flow states likely contribute to the development of ARF following CPB.…”

Incidence and outcome of acute kidney injury after open heart surgery in children

“…The study protocol was approved by the Hospital Ethics Commission. Inclusion criteria were as follows: body weight less than 10 kg (1) and intact renal functions (2). We enrolled 30 patients, 12 boys and 18 girls with CHD (Table 2).…”

“…AKI that requires renal replacement therapy (RRT) occurs in approximately 1% (1,2,4). The development of kidney injury is associated with a high mortality, a more complicated hospital course, and a higher risk for infectious complications (2). AKI has a notable increased morbidity risk, including longer duration of ventilation and overall length of stay (12).…”

“…Acute kidney injury (AKI), depending on the specific definition, occurs in up to 52% of all patients who undergo open heart surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). AKI that requires renal replacement therapy (RRT) occurs in approximately 1% (1,2,4).…”