Adequacy of peritoneal dialysis in children following cardiopulmonary bypass surgery

Abstract

Acute renal failure requiring renal replacement therapy can complicate cardiopulmonary bypass in children. Peritoneal dialysis has been shown to stabilize electrolytes and improve fluid status in these patients. To assess dialysis adequacy in this setting, we prospectively measured Kt/V and creatinine clearance in five patients (6-839 days of age) requiring renal replacement therapy at our institution. Median dialysis creatinine clearance was 74.25 L/week/1.73m(2) (range 28.28-96.63 L/week/1.73m(2)). Residual renal function provided additional solute clearance as total creatinine clearance was 215.97 L/week/1.73m(2) (range 108.04-323.25 L/week/1.73m(2)). Dialysis Kt/V of >2.1 (median 4.84 [range 2.12-5.59]) was achieved in all patients. No dialysis-associated complications were observed. We conclude that peritoneal dialysis is a safe, simple method of providing adequate clearance in children who develop acute renal failure following exposure to cardiopulmonary bypass.

Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance

“…Fluid overload is a common complication following cardiac surgery in infants. Several treatments have been proposed to treat fluid overload in the context of cardiac failure and cardiac surgery including diuretics and peritoneal dialysis [1–5]. Most patients with heart failure who require diuretic therapy are treated with loop diuretics as they are powerful agents [7].…”

“…Conservative management such as the use of diuretics is often insufficient to adequately manage fluid overload. Ultrafiltration through peritoneal dialysis or hemodialysis can be used in severe cases [4, 5], but may not be well tolerated. The insertion of a peritoneal drain and its use to remove peritoneal fluid postoperatively is commonly used in pediatric cardiac surgery especially when newborns with complex diseases are involved but data have never been published.…”

Épuration extrarénale en réanimation adulte et pédiatrique. Recommandations formalisées d’experts sous l’égide de la Société de réanimation de langue française (SRLF), avec la participation de la Société française d’anesthésie-réanimation (Sfar), du Groupe francophone de réanimation et urgences pédiatriques (GFRUP) et de la Société francophone de dialyse (SFD)

“…Les indications principales rapportées dans la littérature sont la déplétion hydrosodée en période postopératoire de chirurgie cardiaque et le traitement de l'IRA isolée. Plusieurs études confirment l'efficacité de la DP dans ces indications [120][121][122][123][124][125][126][127][128][129][130]. Les délais d'obtention d'une épuration efficace ne permettent pas d'utiliser la DP dans une indication urgente.…”

Delivery of Renal Replacement Therapy in Acute Kidney Injury

“…More recently, CRRT was reported to be superior to PD in treating patients with malariainduced AKI (16), and this may have been due to the dosage of PD delivered, because the rate of creatinine clearance and correction of acidosis were much inferior during PD therapy; however, PD has been shown to be a clinically effective therapy in treating AKI, particularly in children after cardiac surgery. Very few studies have monitored the dosage of PD delivered to patients in AKI; one such study reported a weekly Kt/V urea in excess of 2.1, with a median creatinine clearance of 74.3 L/wk per 1.73 m 2 in children after cardiac surgery (17). Just as no studies have examined the optimum dosage of PD required for patients with single-organ and/or multiple-organ failure, there is a similar paucity of data on the recently introduced hybrid treatments (e.g., Genius, EDD, SLED).…”