Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery

The aim of the study was to investigate renal function and indication, efficacy and complications of peritoneal dialysis after cardiopulmonary bypass surgery in children. Methods. Patient characteristics (sex, age, diagnosis), operation type and death were listed. The study was performed retrospectively using serum creatinine level before and peak values after cardiopulmonary bypass surgery for assessment of renal function. Acute renal insufficiency is defined as at least doubling of preoperative serum creatinine level. Of the children who required peritoneal dialysis indication, efficacy and complications were recorded from medical records. Results: In a 5-year period, 1075 children had cardiopulmonary by-pass surgery. 180 (17%) patients developed acute renal in- sufficiency. As is expected after relatively short and simple operations like atrial septum defect closure few children develop acute renal insufficiency (0.7%). After more complicated operations with long cardiopulmonary bypass times, like arterial switch operation and common arterial truncus correction, there is a high incidence of acute renal insufficiency (59 and 53% respectively). Twenty-five (2.3%) patients required renal replacement therapy. Complications of PD were minor. No patient developed peritonitis. However 15 (60%) of 25 children on renal replacement therapy died of non renal causes. In 9 out of 10 surviving children renal function was normal at time of discharge from hospital. Conclusion: Acute renal insufficiency is a frequent complication after open-heart surgery although renal replacement therapy was infrequently necessary. Peritoneal dialysis is a safe and effective method for children after cardiac bypass surgery.