Pediatrics & Neonatology
Volume 50, Issue 6 , Pages 275-279, December 2009

Peritoneal Dialysis in Infants and Children After Open Heart Surgery

  • Jen-Chung Chien

      Affiliations

    • Department of Pediatrics, Lo-Tung Pohai Hospital, Ilan, Taiwan
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Be-Tau Hwang

      Affiliations

    • Department of Pediatrics, Zhongxiao Branch, Taipei City Hospital, Taipei, Taiwan
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
    • Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Zen-Chung Weng

      Affiliations

    • Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
    • Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan
    • ,
  • Laura Chun-Chang Meng

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
    • ,
  • Pi-Chang Lee

      Affiliations

    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
    • Department of Pediatrics, National Yang-Ming University School of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorresponding author. Division of Pediatric Cardiology, Department of Pediatrics, Taipei Veterans General Hospital, 201 Shih-Pai Road, Section 2, Taipei, Taiwan

Received 9 January 2009; received in revised form 9 April 2009; accepted 28 April 2009.

Article Outline

Background

Infants and children who undergo surgical repair of complex congenital heart diseases are prone to developing renal dysfunction. The purpose of this study was to investigate the risk factors associated with prolonged peritoneal dialysis (PD) and the mortality of pediatric patients with acute renal failure (ARF) after open heart surgery.

Methods

From June 1999 to May 2007, a total of 542 children underwent open heart surgery for congenital heart disease. Fifteen (2.8%) experienced ARF and seven (1.3%) required PD. The clinical and laboratory variables were compared between the survivor and non-survivor groups of ARF patients that needed PD.

Results

The non-survivors (n = 3, 43%) had a longer cardiopulmonary bypass time (154 ± 21 vs. 111 ± 8 minutes, p = 0.012) and longer aorta clamping time (92 ± 40 vs. 66 ± 15 minutes, p = 0.010) than the survivors (n = 4, 57%). Before the PD, the pH and base excess of the arterial blood gas analysis in the survivors was much higher than that non-survivors (7.30 ± 0.04 vs. 7.16 ± 0.10, p = 0.039; −5.15 ± 3.13 vs. −12.07 ± 2.9 mmol/L, p = 0.031). Furthermore, the survivors had a shorter interval between the onset of ARF and the day the PD was begun (1.2 ± 0.4 vs. 4.3 ± 1.2 days, p = 0.001), and shorter duration of PD (6.6 ± 2.7 vs. 13.0 ± 3.5 days, p= 0.036) than non-survivors.

Conclusion

Early intervention with PD is a safe and effective method for managing patients with ARF after open heart surgery. The cardiopulmonary bypass and aortic clamping duration, time of initiating PD, duration of the PD, sepsis, and relative complications may predict the prognosis of these patients.

Key Words:  acute renal failure , congenital heart disease , open heart surgery , peritoneal dialysis

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PII: S1875-9572(09)60077-2

doi:10.1016/S1875-9572(09)60077-2

Pediatrics & Neonatology
Volume 50, Issue 6 , Pages 275-279, December 2009

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