Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants

Kwiatkowski, David M.; Menon, Shina; Krawczeski, Catherine D.; Goldstein, Stuart L.; Morales, David L.S.; Phillips, Alistair; Manning, Peter B.; Eghtesady, Pirooz; Wang, Yu; Nelson, David P.; Cooper, David S.

doi:10.1016/j.jtcvs.2013.11.040

Cited by 95 publications

(119 citation statements)

References 29 publications

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“…Some data suggest that early PD may decrease mortality and may not have an adverse effect on kidney recovery following AKI after congenital heart surgery. 24,25 This finding combined with that discussed above regarding preoperative small kidneys by renal ultrasound makes a reasonable argument for prophylactic placement of PD catheters in these select neonates.…”

Section: Discussionmentioning

confidence: 68%

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Piggott

Soni

DeCampli

et al. 2015

World J Pediatr Congenit Heart Surg

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Section: Discussionmentioning

confidence: 68%

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Piggott

Soni

DeCampli

et al. 2015

World J Pediatr Congenit Heart Surg

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“…Serum IL-6 increases as early as 2 hours in patients with AKI 17 and increased levels predict prolonged mechanical ventilation 17 and increased mortality 18 . Of particular relevance to the present report are the results of two recent clinical trials investigating the effects of early RRT in AKI demonstrating reduced serum IL-6 that was associated with reduced mechanical ventilation 19,20 . In the more recent study, early RRT versus later RRT was performed with continuous venovenous hemodiafiltration (CVVHDF, a convective technique) in critically ill adults in the ICU with AKI; early RRT was associated with a significant reduction in serum IL-6 24 hours after RRT initiation and reduced mechanical ventilation time (125 hours versus 181 hours) 19 .…”

Section: Discussionmentioning

confidence: 69%

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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“…Fluid overload that results in hydrostatic (cardio genic) pulmonary oedema has long been recognized as a cause of respiratory failure after AKI. 24,[61][62][63] In paediatric patients at high risk of AKI, achievement of a net even fluid balance with peritoneal dialysis at the time of cardiac surgery resulted in ~25% fewer hours of mechanical ventilation. 60 In general, fluid overload is associated with higher mortality in patients with AKI, 28,64 with one study finding the adjusted odds ratio for mortality in patients with AKI and fluid overload at the time of initiating RRT to be 2.07 (95% CI 1.27-3.37) compared to patients with AKI without fluid overload.…”

Section: Respiratory Complications In Akimentioning

confidence: 99%

Mechanisms and mediators of lung injury after acute kidney injury

2015

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Acute kidney injury (AKI) is a common complication in hospitalized patients, associated with >50% mortality in those in intensive care who require renal replacement therapy. Data suggest that AKI is a systemic disease that adversely affects the immune system and organ function, and in this way contributes to the high mortality observed in affected patients. Data from patients and animal models indicate that AKI adversely affects the lungs. Respiratory complications are common in patients with AKI and include pulmonary oedema, respiratory failure requiring mechanical ventilation, prolonged duration of mechanical ventilation, and prolonged weaning from mechanical ventilation. The development of respiratory failure in patients with AKI greatly increases the risk of death. Data from animal models support the notion that cardiogenic pulmonary oedema (from volume overload) and non-cardiogenic pulmonary oedema (from endothelial injury due to inflammation and apoptosis) can occur in AKI. In this Review we discuss the clinical, epidemiologic, and animal data that provide insights into the mechanisms by which AKI can lead to lung injury and respiratory complications. Elucidation of the mechanisms of lung injury and respiratory complications after AKI is essential to develop effective therapies and reduce the high mortality associated with AKI and respiratory failure.

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Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants

Cited by 95 publications

References 29 publications

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

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

Mechanisms and mediators of lung injury after acute kidney injury

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