Reemplazo renal en el post-operatorio de niños sometidos a cirugía cardíaca con circulación extracorpórea

Abstract

Renal replacement therapy after cardiac surgery with extracorporeal circulation Objective: Acute kidney injury (AKI) is a frequent complication of cardiac surgery with cardiopulmonary bypass (CPB). The aim of this study was to determine the incidence of renal replacement therapy (RRT) requirement in children undergoing surgical repair for congenital cardiopathies and identify the risk factors for requiring RRT. Patients and Methods: A retrospective, descriptive study was performed. The records of patients under 18 years undergoing cardiac surgery with CPB (January 2001 to July 2008) who required RRT (n = 15) and from a random patients sample that did not require it (n = 57) were analysed. Results: Fifteen children out of 942 required acute RRT (1.6%). Initial RRT was peritoneal dialysis (PD) in all of them. The main indications were hypervolemia and/or oligoanuria. Ten patients experienced complications associated to therapy and 14 patients had a history of serious intraoperative events. In multivariated analysis, hypotension (OR 36.0, CI 95%: 5.5-235.6) and serious low cardiac output (LCO) (OR 14.1, CI 95%: 1.47-135.32) were signifi cant risk factors for RRT requirement. In turn, the presence of intraoperative events was signifi cantly associated with the occurrence of hypotension (OR 28.9, CI 95%: 3.6-233.9) and LCO (OR 5.3, CI 95%: 1.1-26.6) during the post-surgical evolution. Conclusion: In this experience, severe hypotension and low cardiac output were signifi cant risk factors for RRT requirement. The incidence of RRT was 1.6%. Renal function should be closely evaluated in those patients with surgical events. RRT should be early considered in those patients with risk factors for renal failure.

Tools for managing childcare in the postoperative period of cardiac surgery: an integrative review

“…A research (24) carried out in Chile, reported that the incidence of RRT in the postoperative period of cardiac corrections with ECC was lower than that reported in other studies (31)(32)34) . However, it highlighted the implementation of ultrafiltration at the end of ECC in almost all patients, which facilitated strict volume control in the postoperative period and reduced the need for RRT due to hypervolemia.…”

“…Among the complications associated with the postoperative period of CHD, the most prevalent is Acute Renal Insufficiency (ARI). This does not depend on the technological advances of ECC, as well as the procedures in the intra and postoperative period, corresponds to a high rate of postoperative morbidity and mortality (30) , with reported incidence between 17 and 72% (24) .…”

“…The twelve articles selected (6,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Regarding the place of publication of the studies, eight were international, conducted in the United States of America (USA) (23) .…”

“…Renal replacement therapy after cardiac surgery with extracorporeal circulation LILACS Rev Chil Pediatr 2012 Ovalle P, Vogel A, Córdova G, Cerda J, Cavagnaro SM F (24) .…”

Efectos de la injuria renal isquémica aguda en la disfunción extrarenal: Estudio experimental aleatorizado

“…De los varios modelos animales de lesión renal aguda, la isquemia reperfusión renal es uno de los más comúnmente estudiados porque es reproducible y se puede graduar fácilmente la magnitud de la lesión. Además tiene implicancia clínica en cirugía cardíaca con clampeo aórtico, transplante renal, nefrectomía parcial, paro cardíaco, entre otros [5][6][7][8] .…”