Skip to main content
SpringerLink
Log in

Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality

  • Original Article
  • Published:
Pediatric Cardiology Aims and scope Submit manuscript

Abstract

Acute kidney injury (AKI) is frequent in the postoperative period of pediatric heart surgery and leads to significant morbidity and mortality. Renal replacement therapies (RRTs) are often used to treat AKI; however, these therapies have also been associated with higher mortality rates. Earlier initiation of RRT might improve outcomes. This study aims to investigate the relationship between the RRT and morbidity and mortality after pediatric heart surgery. We performed a single-center retrospective study of all children undergoing pediatric heart surgery between April 2010 and December 2012 at a tertiary children’s hospital. A total of 480 patients were included. Of those, 109 (23 %) were neonates and 126 patients (26 %) developed AKI within the first 72 postoperative hours. Patients who developed AKI had longer PICU admissions [12 days (4–37.75) vs. 4 (2–11); p < 0.001] and hospital length of stay [27 (11–53) vs. 14 (8–24) p < 0.001] and higher mortality [22/126 (17.5 %) vs. 13/354 (3.7 %); p < 0.001]. RRT techniques were used in 32 (6.6 %) patients [18/109 (16 %) neonates and 14/371 (3.8 %) infants and children; p < 0.01], with 25 (78 %) receiving peritoneal dialysis (PD) and 7 (22 %) continuous RRT (CRRT). Patients who received PD within the first 24 postoperative hours had lower mortality compared with those in whom PD was initiated later [4/16 (25 %) vs. 4/9 (44.4 %)]. Mortality among patients who received CRRT was 28.6 % (2/7). No deaths were reported in patients treated with CRRT within the first 24 postoperative hours. Postoperative AKI is associated with higher mortality in children undergoing cardiac surgery. Early initiation of RRT, both PD in neonates and CRRT in pediatric patients, might improve morbidity and mortality associated with AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Averbuch N, Birk E, Frenkel G, Gogia O, Shulman OM, Bruckheimer E et al (2014) Percutaneous intraperitoneal catheters in neonates following open heart surgery. J Intensive Care Med 29(3):160–164

    Article  PubMed  Google Scholar 

  2. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A et al (2012) Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94(5):1589–1595

    Article  PubMed  Google Scholar 

  3. Bojan M, Gioanni S, Vouhé PR, Journois D, Pouard P (2012) Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality. Kidney Int 82(4):474–481

    Article  CAS  PubMed  Google Scholar 

  4. De Vecchis R, Esposito C, Ariano C (2014) Efficacy and safety assessment of isolated ultrafiltration compared to intravenous diuretics for acutely decompensated heart failure: a systematic review with meta-analysis. Minerva Cardioangiol 62(2):131–146

    PubMed  Google Scholar 

  5. Hassinger AB, Wald EL, Goodman DM (2014) Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 15(2):131–138

    Google Scholar 

  6. Hazle MA, Gajarski RJ, Yu S, Donohue J, Blatt NB (2013) Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 14(1):44–49

    Google Scholar 

  7. Jefferies JL, Goldstein SL (2013) Cardiorenal [corrected] syndrome: an emerging problem in pediatric critical care. Pediatr Nephrol Berl Ger 28(6):855–862

    Article  Google Scholar 

  8. Kavaz A, Ozçakar ZB, Kendirli T, Oztürk BB, Ekim M, Yalçinkaya F (2012) Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria. Acta Paediatr Oslo Nor 101(3):e126–e129

  9. Kwiatkowski DM, Menon S, Krawczeski CD, Goldstein SL, Morales DLS, Phillips A et al (2015) Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 149(1):230–236

    Article  PubMed  Google Scholar 

  10. Mariscalco G, Lorusso R, Dominici C, Renzulli A, Sala A (2011) Acute kidney injury: a relevant complication after cardiac surgery. Ann Thorac Surg 92(4):1539–1547

    Article  PubMed  Google Scholar 

  11. Morgan CJ, Zappitelli M, Robertson CMT, Alton GY, Sauve RS, Joffe AR et al (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162(1):120–127.e1

  12. Pickering JW, James MT, Palmer SC (2015) Acute kidney injury and prognosis after cardiopulmonary bypass: a meta-analysis of cohort studies. Am J Kidney Dis Off J Natl Kidney Found 65(2):283–293

    Article  Google Scholar 

  13. Piggott KD, Soni M, Decampli WM, Ramirez JA, Holbein D, Fakioglu H et al (2015) Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease. World J Pediatr Congenit Heart Surg 6(3):401–406

    Article  PubMed  Google Scholar 

  14. Ricci Z, Di Nardo M, Iacoella C, Netto R, Picca S, Cogo P (2013) Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 34(6):1404–1408

    Article  PubMed  Google Scholar 

  15. Ronco C, Ricci Z, Goldstein SL (2015) (R)evolution in the management of acute kidney injury in newborns. Am J Kidney Dis Off J Natl Kidney Found 66(2):206–211

    Article  Google Scholar 

  16. Saini A, Delius RE, Seshadri S, Walters H, Mastropietro CW (2012) Passive peritoneal drainage improves fluid balance after surgery for congenital heart disease. Eur J Cardio Thorac Surg Off J Eur Assoc Cardio Thorac Surg 41(2):256–260

    Article  Google Scholar 

  17. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Sánchez A et al (2012) Evolution and mortality risk factors in children with continuous renal replacement therapy after cardiac surgery. Rev Esp Cardiol Engl Ed 65(9):795–800

    Article  PubMed  Google Scholar 

  18. Santiago MJ, López-Herce J, Urbano J, Solana MJ, del Castillo J, Sánchez A et al (2013) Continuous renal replacement therapy in children after cardiac surgery. J Thorac Cardiovasc Surg 146(2):448–454

    Article  PubMed  Google Scholar 

  19. Tóth R, Breuer T, Cserép Z, Lex D, Fazekas L, Sápi E et al (2012) Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 93(6):1984–1990

    Article  PubMed  Google Scholar 

  20. Valika AA, Costanzo MR (2014) The acute cardiorenal syndrome type I: considerations on physiology, epidemiology, and therapy. Curr Heart Fail Rep 11(4):382–392

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Intensive Care Division, Department of Critical Care Medicine, Children Hospital of Pittsburgh, University of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, USA

    Joan Sanchez-de-Toledo & Tracy Baust

  2. Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Alba Perez-Ortiz

  3. Department of Neonatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Laura Gil & Marcos Linés-Palazón

  4. Unit of Clinical Research Support, Vall d’Hebron Research Institut, Universitat Autònoma de Barcelona, Barcelona, Spain

    Santiago Perez-Hoyos

  5. Department of Pediatric Cardiology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Ferran Gran

  6. Department of Pediatric Cardiothoracic Surgery, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain

    Raul F. Abella

  7. Vall d’Hebron Research Institute, Universitat Autonoma de Barcelona, Passeig de la Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Joan Sanchez-de-Toledo

Authors
  1. Joan Sanchez-de-Toledo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alba Perez-Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tracy Baust
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marcos Linés-Palazón
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Santiago Perez-Hoyos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ferran Gran
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Raul F. Abella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joan Sanchez-de-Toledo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sanchez-de-Toledo, J., Perez-Ortiz, A., Gil, L. et al. Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality. Pediatr Cardiol 37, 623–628 (2016). https://doi.org/10.1007/s00246-015-1323-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00246-015-1323-1

Keywords

Search

Navigation