Peritoneal dialysis after surgery for congenital heart disease in infants and young children

Chan, Kwok-lap; Ip, Patrick; Chiu, Chia-Yu; Cheung, Yiu‐fai

doi:10.1016/s0003-4975(03)01026-9

Cited by 96 publications

(112 citation statements)

References 16 publications

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“…The only RRT used in the study population was peritoneal dialysis. Dialysis was initiated when patients met the commonly accepted criteria (17,18): evidence of fluid overload and positive fluid balance, inadequate urine output (,1 ml/kg per hour) or anuria unresponsive to fluid challenge and intravenous furosemide for at least 4 hours, concomitant low-cardiac-output syndrome, and acid-base or electrolyte disturbances (pH,7.30, serum K + .5.5 mmol/L).…”

Section: Methodsmentioning

confidence: 99%

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Bojan¹,

Vicca

Lopez-Lopez³

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Urine neutrophil gelatinase-associated lipocalin (uNGAL) has been shown to accurately predict and allow early detection of AKI, as assessed by an increase in serum creatinine in children and adults. The present study explores the accuracy of uNGAL for the prediction of severe AKI-related outcomes in neonates and infants undergoing cardiac surgery: dialysis requirement and/or death within 30 days.Design, setting, participants, & measurements Prospective, observational cohort study conducted in a tertiary referral pediatric cardiac intensive care unit, including 75 neonates and 125 infants undergoing surgery with cardiopulmonary bypass between August 1, 2010, and May 31, 2011. Urine samples were collected before surgery and at median of five time points within 48 hours of bypass. Urine NGAL was quantified as absolute concentration, creatinine-normalized concentration, and absolute excretion rate, and a clusterization algorithm was applied to the individual uNGAL kinetics. The accuracy for the prediction of the outcome was assessed using receiver-operating characteristic areas, likelihood ratios, diagnostic odds ratios, net reclassification index, integrated reclassification improvement, and number needed to screen.Results A total of 1176 urine samples were collected. Of all patients, 8% required dialysis and 4% died. Three clusters of uNGAL kinetics were identified, including patients with significantly different outcomes. The uNGAL level peaked between 1 and 3 hours of bypass and remained high in half of all patients who required dialysis or died. The uNGAL levels measured within 24 hours of bypass accurately predicted the outcome and performed best after normalization to creatinine, with varying cutoffs according to the time elapsed since bypass. The number needed to screen to correctly identify the risk of dialysis or death in one patient varied between 1.5 and 2.6 within 12 hours of bypass.Conclusions uNGAL is a valuable predictive tool of dialysis requirement and death in neonates and infants with AKI after cardiac surgery.

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Section: Methodsmentioning

confidence: 99%

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Bojan¹,

Vicca

Lopez-Lopez³

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…4,7,8,13 The mortality rate in children with ARF following heart surgery has been reported ranging from 10-90%. 7,8,[13][14][15][16] Various authors have demonstrated that an earlier initiation of dialysis is associated with a lower mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Although the choice of RRT remains controversial, PD has been demonstrated to be useful in light of the ease of application, effectiveness in fluid removal and avoidance of the need for anticoagulation, and establishment of additional vascular access. 7,8 Some centers routinely implant PD catheter in patients who undergo correction operation for transposition of the great arteries (TGA), whereas others apply only in selected patients. In our practice, all children with ARF following cardiac surgery are routinely treated with PD, which is an effective and safe method that requires no advanced technology.…”

Section: Introductionmentioning

confidence: 99%

Early Initiation of Peritoneal Dialysis after Arterial Switch Operations in Newborn Patients

et al. 2012

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Background and aim: We investigated the clinical outcome of early initiated peritoneal dialysis (PD) use in our newborn patients who underwent arterial switch operation (ASO) for transposition of the great arteries (TGA) and had routine intraoperative PD catheter implantation. We determined the risk factors for PD, factors associated with prolonged PD, morbidity, and mortality. The aim of the present study was to describe our experience of using PD in this patient cohort. Materials and Methods: Eighty two patients who were diagnosed with TGA and TGA-ventricular septal defect (VSD) and who had undergone TGA correction operation in Başkent University, Istanbul Medical Research and Training Hospital between 2007 and 2012 were retrospectively investigated. All the patients were under 30 days old. PD catheters were routinely implanted intraoperatively at the end of the operation. PD was initiated in transient renal insufficiency. In the absence of oliguria and increased creatinine level, PD was established in the presence of one of the following: clinical signs of fluid overload, hyperkalemia (>5 mEq/L), persistent metabolic acidosis, lactate level above 8 mmol/L or low cardiac output syndrome. The patients were divided into two groups according to the need for postoperative PD (PD group and non-PD group). PD was initiated in 32 (39%) patients after the operation, whereas 50 (61%) patients did not need dialysis. The clinical outcomes and perioperative data of the two groups were compared. Results: The demographics in the two groups were similar. Cardiopulmonary bypass time was longer in the PD group [non-PD group, 175.24 AE 32.39 min; PD group, 196.22 AE 44.04 min (p < 0.05)]. Coronary anomaly was found to be higher in the PD group [non-PD group, n ¼ 2 patients (4.0%); PD group, n ¼ 7 patients (21.9%); p < 0.05]. There was more need for PD in TGA þ VSD patients [simple TGA patients, n ¼ 14; TGA þ VSD patients, n ¼ 18 (p < 0.05)]. PD rate was higher in patients whose sterna were left open at the end of the operation (p < 0.05).

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“…In this setting, mortality relates more to the underlying primary cardiac disease than to other medical conditions. Even if the presence of AKI is usually associated with an increased rate of complications, longer hospital stay, and worse prognosis in this setting, the association between AKI and mortality must take into account the overall risk of death because of the underlying cardiac condition (19). In low-risk patients, the correlation between AKI and mortality was strong; in those with higher risk, the association was weaker, because death was attributable not only to AKI but also to other organ failure, especially cardiac failure (4).…”

Section: Discussionmentioning

confidence: 99%

Use of Peritoneal Dialysis after Surgery for Congenital Heart Disease in Children

et al. 2011

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Acute kidney injury (AKI) is a common complication in children after surgery for congenital heart disease, and peritoneal dialysis (PD) is usually the renal replacement therapy (RRT) of choice, especially in very young children. The aim of the present study was to describe our experience of using PD to treat AKI after cardiac surgery.We retrospectively analyzed children 1 week to 16 years of age undergoing cardiac surgery during 2000 -2008 and found the incidence of AKI treated with PD to be 2.3%. In the 23 patients treated with PD (13 male; average age: 29 ± 48.4 months; weight: 9.1 ± 8.1 kg), the indications for PD initiation were oliguria (n = 13), anuria (n = 9), and acidosis (n = 1). The average time between cardiac surgery and AKI was 4.8 ± 16.8 hours, and between AKI and PD initiation, it was 12 ± 16.8 hours. Patients were treated for a mean of 4.8 ± 3.8 days. Two patients developed peritonitis, and mechanical dysfunction of the PD catheter occurred in 1 patient. In-hospital mortality was 43.4%. Patients treated with PD weighed less (p = 0.004) and had longer bypass time (p = 0.004), inotrope use (p = 0.000), and mechanical ventilation (p = 0.000). However, in a regression analysis, only cardiopulmonary bypass time (odds ratio: 1.021; 95% confidence interval: 0.998 to 1.027; p = 0.032) remained predictive of a subsequent need for PD.We conclude that PD is an efficacious RRT for AKI in children undergoing cardiac surgery and that, in this setting, bypass time is the strongest predictor of a subsequent need for RRT.

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Peritoneal dialysis after surgery for congenital heart disease in infants and young children

Cited by 96 publications

References 16 publications

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Predictive Performance of Urine Neutrophil Gelatinase-Associated Lipocalin for Dialysis Requirement and Death Following Cardiac Surgery in Neonates and Infants

Early Initiation of Peritoneal Dialysis after Arterial Switch Operations in Newborn Patients

Use of Peritoneal Dialysis after Surgery for Congenital Heart Disease in Children

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