Prophylactic Peritoneal Dialysis Following Cardiopulmonary Bypass in Children Is Associated with Decreased Inflammation and Improved Clinical Outcomes

Sasser, William C; Dabal, Robert J.; Askenazi, David; Borasino, Santiago; Moellinger, Ashley; Kirklin, James K.; Alten, Jeffrey A.

doi:10.1111/chd.12072

Cited by 81 publications

(57 citation statements)

References 36 publications

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“…Although the role of convective therapies in cytokine removal in AKI remains controversial, the result of this trial is consistent with the notion that IL-6 removal in patients with AKI may improve pulmonary outcomes. In the second study, children that received PD immediately after bypass-requiring cardiac surgery had a significant reduction in serum IL-6 that was associated with improved clinical outcomes including shorter duration of mechanical ventilation (71 hours versus 125 hours) 21 . Because of better clinical outcomes 4,20,21 , prophylactic PD is actually standard practice after cardiac surgery in children in some centers 20,22 .…”

Section: Discussionmentioning

confidence: 98%

“…In the second study, children that received PD immediately after bypass-requiring cardiac surgery had a significant reduction in serum IL-6 that was associated with improved clinical outcomes including shorter duration of mechanical ventilation (71 hours versus 125 hours) 21 . Because of better clinical outcomes 4,20,21 , prophylactic PD is actually standard practice after cardiac surgery in children in some centers 20,22 . Thus, our model of PD in AKI seems to be particularly clinically relevant to children receiving PD early after cardiac surgery, which is associated with a high risk of AKI.…”

Section: Discussionmentioning

confidence: 98%

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Early peritoneal dialysis reduces lung inflammation in mice with ischemic acute kidney injury

Altmann

Ahuja

Kiekhaefer

et al. 2017

Kidney International

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Although dialysis has been used in the care of patients with acute kidney injury (AKI) for over 50 years, very little is known about the potential benefits of uremic control on systemic complications of AKI. Since the mortality of AKI requiring renal replacement therapy (RRT) is greater than half in the intensive care unit a better understanding of the potential of RRT to improve outcomes is urgently needed. Therefore, we sought to develop a technically feasible and reproducible model of RRT in a mouse model of AKI. Models of low and high dose peritoneal dialysis (PD) were developed and their effect on AKI, systemic inflammation, and lung injury after ischemic AKI was examined. High dose PD had no effect on AKI, but effectively cleared serum IL-6, and dramatically reduced lung inflammation while low dose PD had no effect on any of these three outcomes. Both models of RRT using PD in AKI in mice reliably lowered urea in a dose dependent fashion. Thus, use of these models of PD in mice with AKI has great potential to unravel the mechanisms by which RRT may improve the systemic complications that have led to increased mortality in AKI. In light of recent data demonstrating reduced serum IL-6 and improved outcomes with prophylactic PD in children, we believe our results are highly clinically relevant.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Early peritoneal dialysis reduces lung inflammation in mice with ischemic acute kidney injury

Altmann

Ahuja

Kiekhaefer

et al. 2017

Kidney International

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“…The Ig measurements in this study came from banked plasma stored during a clinical trial evaluating the impact of PD after complex cardiac surgery [13]. Patients in this previous study had a peritoneal drain which was either used for PD (initiated at median 2.5 hours after CICU admission) or left to passive peritoneal drainage.…”

Section: Discussionmentioning

confidence: 99%

Hypogammaglobulinemia after cardiopulmonary bypass in infants

Rhodes

Robert

Atkinson

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Background Hypogammaglobulinemia has been reported after cardiac surgery and may be associated with adverse outcomes. We sought to define baseline immunoglobulin (Ig) concentration in neonates and infants with congenital heart disease, determine its course following cardiopulmonary bypass (CPB), and determine if post-CPB hypogammaglobulinemia was associated with increased morbidity. Methods Single center, retrospective analysis of infants who underwent cardiac surgery with CPB between June 2010 and December 2011. Ig concentration obtained from banked plasma of 47 patients from a prior study (pre-CPB, immediately post-CPB, and 24- and 48-hours post-CPB). Additionally, any Ig levels drawn for clinical purposes after CPB were included. Ig levels were excluded if drawn after chylothorax diagnosis or intravenous immunoglobulin G administration. Results Median age was 7 days. Preoperative Ig concentration was similar to that described in healthy children. IgG level fell to less than 50% of preoperative concentration by 24-hr post-CPB and failed to recover by 7 days. 25/47 (53%) patients had low IgG after CPB (<248 mg/dl). Despite no difference in demographics or risk factors between patients with low and normal IgG, low IgG patients had more positive fluid balance at 24-hours, increased pro-inflammatory plasma cytokine levels, duration of mechanical ventilation, and CICU length of stay. Additionally, low IgG patients had increased incidence of post-operative infections (40% vs. 14%, p=0.056). Conclusions Hypogammaglobulinemia occurs in half of infants after CPB. Its association with fluid overload and increased inflammatory cytokines suggests it may result from capillary leak. Postoperative hypogammaglobulinemia is associated with increased morbidity, including more secondary infections.

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“…Median net fluid balance was more negative in the prophylactic PD group at 24 h (−24 vs. +18 mL/kg) and at 48 h (−88 vs. −46 mL/kg). The prophylactic PD group had less fluid intake and lower inotrope score at 24 h and earlier sternal closure [46]. With regard to the timing for discontinuation of PD, Riley et al showed in a prospective randomized controlled study that PD continuation for a further 24 h was not effective in 20 infants under 90 days old.…”

Section: Introductionmentioning

confidence: 99%

AKI after pediatric cardiac surgery for congenital heart diseases–recent developments in diagnostic criteria and early diagnosis by biomarkers-

Toda

Sugimoto

2017

j intensive care

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BackgroundAcute kidney injury (AKI) after cardiac surgery in children with congenital heart disease is a common complication. AKI is also associated with high morbidity and mortality. The Kidney Diseases Improving Global Outcomes (KDIGO) criteria for AKI classification are now widely used for the definition of AKI. It is noteworthy that a statement about children was added to the criteria. Many studies aimed at finding useful biomarkers are now being performed by using these criteria. Clinicians should be aware of the recent progress in understanding AKI in children.Main contentsUnlike adult patients, young age is one of the major risk factors for AKI in pediatric cardiac surgery. The mechanism of the development of AKI in children might be different from that in adults because the surgical procedure and CPB technique in pediatric patients are greatly different from those in adult patients.There are many biomarkers for early detection of AKI, and some of them are widely used in hospitals. One of the major benefits of such biomarkers is the rapidness of expression for detecting increases in their expression levels. Neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, cystatin C, and albumin have been investigated in some studies, and the usefulness of these biomarkers for detection of AKI and diagnosis of disease severity has been shown.Although there are many interventions for preventing and treating AKI after cardiac surgery in children, there is still no specific effective treatment. Peritoneal dialysis is effective for only maintaining a negative fluid balance early after cardiac surgery. The long-term prognosis of AKI is an issue of interest. Although mortality and morbidity of AKI in the acute phase of disease remain high, the long-term condition in pediatric patients is relatively acceptable unlike in adults.ConclusionsKDIGO criteria are advocated as a diagnostic tool for common perception. Early recognition and intervention for AKI can be achieved by using several biomarkers. Further studies are needed to establish effective treatment for AKI.

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Prophylactic Peritoneal Dialysis Following Cardiopulmonary Bypass in Children Is Associated with Decreased Inflammation and Improved Clinical Outcomes

Abstract: Prophylactic PD is associated with greater net negative fluid balance, decreased inotrope requirements, and lower serum concentrations of inflammatory cytokines in the early postoperative period.

Cited by 81 publications

References 36 publications

Early peritoneal dialysis reduces lung inflammation in mice with ischemic acute kidney injury

Early peritoneal dialysis reduces lung inflammation in mice with ischemic acute kidney injury

Hypogammaglobulinemia after cardiopulmonary bypass in infants

AKI after pediatric cardiac surgery for congenital heart diseases–recent developments in diagnostic criteria and early diagnosis by biomarkers-

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