Acute Renal Insufficiency and Renal Replacement Therapy After Pediatric Cardiopulmonary Bypass Surgery

Abstract

The aim of the study was to investigate renal function and renal replacement therapy after cardiopulmonary bypass surgery in children. Patient characteristics (sex, age, diagnosis), operation type, and death were listed. The study was performed retrospectively using serum creatinine level before, and peak values after, cardiopulmonary bypass surgery for assessment of renal function. Of the children on renal replacement therapy, indication, efficacy, and complications were recorded. In a 5-year period, 1075 children had cardiopulmonary bypass surgery at the Department of Cardiothoracic Surgery at Leiden University Medical Center and Academic Medical Center of Amsterdam. One-hundred eighty (17%) patients developed acute renal insufficiency. Twenty-five (2.3%) patients required renal replacement therapy. Peritoneal dialysis is a safe and effective treatment for children after cardiopulmonary bypass surgery. However, 15 (60%) of 25 children on renal replacement therapy died of nonrenal causes. In 9 out of 10 surviving children, renal function was normal at time of discharge from hospital. Acute renal insufficiency is a frequent complication after open-heart surgery, although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective therapeutic measure for children after cardiac bypass surgery.

Zero Mortality of Continuous Veno-venous Hemodiafiltration with PMMA Hemofilter after Pediatric Cardiac Surgery

“…[1][2][3] Continuous veno-venous hemodiafiltration (CVVH) is used as one of the modalities of CRRT in pediatric intensive care units. ARF is still a frequent complication following extensive pediatric cardiac surgery due to low cardiac output, massive hemolysis and high fluid overload.…”

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

“…[12] Peritoneal dialysis is the first-line RRT modality which is relatively easy to employ, effective, and has a low complication rate to be used for ARF in these patients. [1,4,13,14] Several studies have attempted to identify the risk factors of ARF requiring RRT in pediatric patients undergoing congenital cardiac surgery. [2,7,14] In consistent with previous studies, [15][16][17] patients who showed recovery of renal function following PD with associated lower CPB and CC times, RACHS-1 category and inotrope scores, BUN and SCr values before PD and a lower time interval between surgery and PD had lower mortality.…”

“…[ 1,19] In addition, the incidence of postoperative ARF can be as high as 42% with an incidence of 1 to 17% for dialysis and a mortality rate of 20 to 100%. [12,15,16,19,20] The incidence of ARF, which required PD and mortality rate following congenital cardiac surgery in our study population, were 7.9% and 72.2%, respectively.…”

“…In some centers, peritoneal catheters are prophylactically placed in infants who are at a high risk of ARF and CPB following surgery, whereas these catheters are used by other centers, including ours, to serve as a continuous drain of the abdominal cavity, for the dialysis of persistent low urinary output, to correct electrolytes and metabolic status, or to remove fluid. [1] In a study conducted by Dittrich et al, [24] in which the prophylactic and early use of PD was applied in the presence of risk factors for ARF, improved control of fluid balance and a more favorable patient outcomes with a mortality rate of 27% were reported.…”

“…[1][2][3] Despite progress in cardiac surgery and intensive care techniques, the mortality rate still remains high (ranging from 20 to 79%) in this group of patients. [2,4] Peritoneal dialysis (PD) is the most widely available form of renal replacement therapy used in neonates, infants, and children.…”