Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery

doi:10.1016/S0003-4975(03)01490-5

The Annals of Thoracic Surgery

Volume 77, Issue 1, January 2004, Pages 61-65

https://doi.org/10.1016/S0003-4975(03)01490-5 Get rights and content

Abstract

Background

The development of renal dysfunction in the postoperative course of cardiac surgery is still associated with high mortality in pediatric patients. In particular for small infants peritoneal dialysis offers a secure and useful treatment option. The aim of the present study was to investigate if routinely used laboratory and clinical variables could help predict mortality at initiation of peritoneal dialysis.

Methods

We performed a retrospective chart analysis of pediatric intensive care unit patients with renal dysfunction who were treated with peritoneal dialysis after cardiac surgery between 1993 and 2001 and analyzed variables obtained 3 hours or less before starting peritoneal dialysis.

Results

Results are documented as means and standard errors. A total of 1,141 children underwent a cardiac operation on cardiopulmonary bypass. Sixty-two children (5.4%) were treated with peritoneal dialysis. Mortality was 40.3% (37 survivors, 25 nonsurvivors). The pH in survivors was 7.35 (0.01); in nonsurvivors it was 7.23 (0.03; p = 0.0037). Base excess in survivors was −1.37 mmol/L (0.61); in nonsurvivors it was −7.17 mmol/L (1.49; p = 0.0026). Lactate in survivors was 4.5 mmol/L (0.60); in nonsurvivors it was 10.5 mmol/L (1.78; p = 0.0089). Positive inspiratory pressure in survivors was 24.6 cmH₂O (0.78); in nonsurvivors it was 28.9 cmH₂O (1.08; p = 0.0274). Tidal volume per kilogram bodyweight in survivors was 11.0 mL/kg (0.48); in nonsurvivors it was 8.7 mL/kg (0.50; p = 0.0493).

Conclusions

We conclude from our data that the consideration of pH, base excess, lactate, positive inspiratory pressure, and tidal volume per kilogram bodyweight help predict mortality at initiation of peritoneal dialysis. We were able to observe significant differences between survivors and nonsurvivors using these variables.

Section snippets

Study population

The records of all children with peritoneal dialysis after cardiac surgery by means of cardiopulmonary bypass who were treated in our pediatric intensive care unit between June 1993 and December 2001 were reviewed retrospectively. Exclusion criteria were a postoperative course of extracorporeal membrane oxygenation, peritoneal dialysis for less than 1 day, or incomplete data. Hemodynamic data were continuously monitored by means of a Hewlett-Packard monitoring system (Model 68 S;

Results

Between June 1993 and December 2001, 1,141 children underwent a cardiac operation on cardiopulmonary bypass at the University hospital of Vienna. A total of 62 of the 1,141 children (5.4%) were treated with peritoneal dialysis and were eligible for this retrospective study. Table 1shows the different congenital heart defects and the operations performed. Table 2shows the number of patients of each indication for peritoneal dialysis. The cause of death was low cardiac output in 21 cases (acute

Comment

In this retrospective study we reviewed the medical records of pediatric intensive care unit patients treated for renal dysfunction after cardiac surgery. When we compared survivors and nonsurvivors we found that pH, base excess, lactate, PIP, and TV/kg could significantly identify children at high risk of mortality at time of peritoneal dialysis initiation after cardiac surgery whereas mean arterial pressure, central venous blood pressure, central venous oxygen saturation, and urinary output

Acknowledgements

The authors would like to thank Thomas Lang, MS, for his expertise in biostatistics.

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Original article: cardiovascularPredictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery

Abstract

Background

Methods

Results

Conclusions

Section snippets

Study population

Results

Comment

Acknowledgements

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Pediatr Surg

Br J Anaesth

Choice of dialysis modality for management of pediatric acute renal failure

Pediatr Nephrol

Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management

Tex Heart Inst J

Resampling-based multiple testing

Risks of acute renal failure after cardiopulmonary bypass surgery in childrena retrospective 10-year case-control study

Nephrol Dial Transplant

Original article: cardiovascular
Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery