Predictors of early peritoneal dialysis initiation in newborns and young infants following cardiac surgery

• Published in: Cardiology in the young Vol. 34; no. 6; p. 1239
• Main Authors: Rivera-Figueroa, Elvia, Ansari, Md Abu Yusuf M, Mallory, Emily Turner, Garg, Padma, Onder, Ali Mirza
• Format: Journal Article
• Language: English
• Published: England 01-06-2024
• Subjects: Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiopulmonary Bypass - adverse effects; Cardiopulmonary Bypass - methods; Creatinine - blood; Female; Heart Defects, Congenital - surgery; Humans; Infant; Infant, Newborn; Logistic Models; Male; Peritoneal Dialysis - methods; Postoperative Complications - epidemiology; Retrospective Studies; Time Factors; urine output; peritoneal dialysis; newborn; fluid overload; congenital heart surgery
• ISSN: 1467-1107
• DOI: 10.1017/S1047951123004286

This single-centre, retrospective cohort study was conducted to investigate the predictors of early peritoneal dialysis initiation in newborns and young infants undergoing cardiac surgery.
There were fifty-seven newborns and young infants. All subjects received peritoneal dialysis catheter after completion of the cardiopulmonary bypass. Worsening post-operative (post-op) positive fluid balance and oliguria (<1 ml/kg/hour) despite furosemide were the clinical indications to start early peritoneal dialysis (peritoneal dialysis +). Demographic, clinical, and laboratory data were collected from the pre-operative, intra-operative, and immediately post-operative periods.
Baseline demographic data were indifferent except that peritoneal dialysis + group had more newborns. Pre-operative serum creatinine was higher for peritoneal dialysis + group (p = 0.025). Peritoneal dialysis + group had longer cardiopulmonary bypass time (p = 0.044), longer aorta cross-clamp time (p = 0.044), and less urine output during post-op 24 hours (p = 0.008). In the univariate logistic regression model, pre-op serum creatinine was significantly associated with higher odds of being in peritoneal dialysis + (p = 0.021) and post-op systolic blood pressure (p = 0.018) and post-op mean arterial pressure (p=0.001) were significantly associated with reduced odds of being in peritoneal dialysis + (p = 0.018 and p = 0.001, respectively). Post-op mean arterial pressure showed a statistically significant association adjusted odds ratio = 0.89, 95% confidence interval [0.81, 0.96], p = 0.004) with peritoneal dialysis + in multivariate analysis after adjusting for age at surgery.
In our single-centre cohort, pre-op serum creatinine, post-op systolic blood pressure, and mean arterial pressure demonstrated statistically significant association with peritoneal dialysis +. This finding may help to better risk stratify newborns and young infants for early peritoneal dialysis start following cardiac surgery.