Peritoneal dialysis requirements following open-heart surgery in children with congenital heart disease.

ABSTRACT

This article reviews our experience with 111 pediatric patients following open-heart surgery over 1-year period. Peritoneal dialysis was required in 34 of 111 children (30.6%). We randomly selected 33 patients who did not require peritoneal dialysis as control group. The indications of dialysis were oligoanuria and/or elevated serum creatinine level (19/34, 55.8%), fluid overload and/or hemodynamic alterations (10/34, 29.5%), and hyperkalemia and/or acidosis (5/34, 14.7%). Among the 34 dialyzed patients, 19 (55.6%) had acute renal failure (ARF). Cyanotic congenital heart disease was significantly higher in patients who required dialysis than the patients who did not require dialysis (67.6% and 22.6%, respectively, p < 0.001). Cardiopulmonary bypass time was significantly longer in patients with ARF than those without ARF (p < 0.05). Overall mortality rate was significantly higher in patients who required dialysis than control group (42.1% and 18.2%, respectively, p < 0.05). However, in the dialyzed group the mortality for patients who developed ARF was 68.4% and 6.7% for those who did not develop ARF [odds ratio (OR) 30.3, confidence interval (CI) 95% 3.2-28.7, p < 0.001]. In conclusion in children high mortality rate following open-heart surgery was associated with ARF. Patients with cyanotic congenital heart disease and prolonged cardiopulmonary bypass time are at risk for ARF. The presence of these factors can be predicted in the early institution of peritoneal dialysis after cardiac surgery.