Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE 8 ( August, 2019 ) > List of Articles

COMMENTARY

Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients

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

Keywords : Cardiopulmonary bypass, Pediatric cardiac surgery, Peritoneal dialysis, Postoperative period

Citation Information : Sahu MK, C B, Arora Y, Singh SP, Devagouru V, Rajshekar P, Chaudhary SK. Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients. Indian J Crit Care Med 2019; 23 (8):371-375.

DOI: 10.5005/jp-journals-10071-23221

License: CC BY-NC 4.0

Published Online: 00-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: 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. Materials and Methods: The 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. Results: Six 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). Conclusion: PD 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.


PDF Share
  1. Werner HA, Wensley DF, Lirenman DS, LeBlanc JG. Peritoneal dialysis in children after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1997;113:64–68.
  2. Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser CD. Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 1999;13:641–645.
  3. Kist-van Holthe tot Echten JE, Goedvolk CA, Doornaar MB, van der Vorst MM, Bosman-Vermeeren JM, Brand R, et al. Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. Pediatr Cardiol 2001; 22:321–326.
  4. Ridgeden SP, Barrat TM, Dillon MJ, de Leval M, Stark J. Acute renal failure complicating cardiopulmonary bypass surgery. Arch Dis Child 1982;57:425–430.
  5. Hanson J, Loftness S, Clarke D, Cambell D. Peritoneal dialysis following open heart surgery in children. Pediatr Cardiol 1989;10:125–128.
  6. Abel RM, Buckley MJ, Austen WG, Barnett GO, Beck CH Jr, Frischer JE. Etiology, incidence and prognosis of renal failure following cardiac operations. J Thorac Cardiovasc Surg 1986;71:323–3.
  7. Fleming F, Bohn D, Edwards H, Cox P, Geary D, Mc Crindle BW, et al. Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. J Thorac Cardiovasc Surg 1995; 109:322–331.
  8. Paret G, Cohen AJ, Bohn DJ, Edwards H, Taylor R, Geary D, et al. Continuous arteriovenous hemofiltration after cardiac surgery operations in infants and children. J Thorac Cardiovasc Surg 1992;104:1225–1230.
  9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:31.
  10. Shaw NJ, Brocklebank JT, Dickinson DF, Wilson N, Walker DR. Long-term outcome for children with acute renal failure following cardiac surgery. Int J Cardiol 1991;31:161–166.
  11. Dittrich S, Dähnert I, Vogel M, Stiller B, Hass NA, Alexi-Meskishvili V, et al. Peritoneal dialysis after infant open heart surgery: observations in 27 patients. Ann Thorac Surg 1999; 68:160–163.
  12. Reznik VM, Griswold WR, Peterson BM, Rodarte A, Ferris ME, Mendoza SA. Peritoneal dialysis for acute renal failure in children. Pediatr Nephrol 1991; 5:715–717.
  13. Giuffre RM, Tam KH, Williams WW, Freedom RM. Acute renal failure complicating pediatric cardiac surgery: a comparison of survivors and non survivors following acute peritoneal dialysis. Pediatr Cardiol 1992;13:208–214.
  14. Chan K, Patrick Ip, Chiu CSW, Cheung YF. Peritoneal Dialysis After Surgery for Congenital Heart Disease in Infants and Young Children. Ann Thorac Surg 2003; 76:1443–1449.
  15. Chien JC, Hwang BT, Weng ZC, Meng LC, Lee PC. Peritoneal dialysis after open heart surgery. Pediatr Neonatol 2009; 50(6):275–279.
  16. Dittrich S, Kurschat K, Dahnert I, Vogel M, Müller C, Alexi-Meskishvili V et al. Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol 2000; 73:173–179.
  17. Lin MC, Fu YC, Fu LS, Jan SL, Chi CS. Peritoneal dialysis in children with acute renal failure after open heart surgery. Acta Paediatr Taiwan 2003; 44:89–92.
  18. Dittrich S, Vogel M, Dahnert I, Hass NA, Alexi-Meskishvili V, Lange PE. Acute hemodynamic effects of post cardiotomy peritoneal dialysis in neonates and infants. Intensive Care Med 2000;26:101–104.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.