Pedersen K R, Hjortdal V E, Christensen S, Pedersen J, Hjortholm K, Larsen S H, Povlsen J V
Department of Cardio Thoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark.
Kidney Int Suppl. 2008 Apr(108):S81-6. doi: 10.1038/sj.ki.5002607.
The present single-center cohort study was based on a clinical intensive care unit database containing data on 1128 consecutive children undergoing their first operation for congenital heart disease between 1993 and 2002 at Aarhus University Hospital, Skejby, Denmark. A total of 130 (11.5%) children developed postoperative acute renal failure (ARF) managed with peritoneal dialysis (PD). Logistic regression analysis was used to examine risk factors for complications related to PD and to compare mortality between ARF and non-ARF patients controlling for potential confounding factors. A total of 43 complications related to PD were registered in 27 (20.8%) patients. Major complications were seen in eight (6.2%) patients, and only two (1.5%) patients were switched to hemodialysis after peritonitis and hemicolectomy due to bowel perforation. The main risk factors for complications to PD were duration of PD, high RACHS-1 score (Risk Adjusted Classification for Congenital Heart Surgery), and hyperkalemia at initiation of PD. Overall, in-hospital mortality was 6.8% (76/1128). Mortality of ARF patients was 20.0% compared to 5.0% among non-ARF patients (adjusted odds ratio=1.91, 95% confidence interval=1.10-3.36). After stratification, ARF was strongly associated with increased mortality in the subgroups of patients with the lowest overall risk of dying (age> or =1 year, body weight> or =5 kg, RACHS-1 score <3, and no preoperative cyanosis). For patients at high risk of dying (age <1 year, body weight <5 kg, RACHS-1 score> or =3, cardiopulmonary bypass time> or =60 min, and preoperative cyanosis), the association between ARF and mortality was substantially weaker. In conclusion, postoperative ARF was associated with increased mortality in children operated for congenital heart disease. Major complications to PD were few, and our data strongly support that PD is a simple, safe, feasible, and robust dialysis modality for the management of ARF in children.
本单中心队列研究基于一个临床重症监护病房数据库，该数据库包含1993年至2002年期间在丹麦斯凯比的奥胡斯大学医院连续接受首次先天性心脏病手术的1128名儿童的数据。共有130名（11.5%）儿童发生术后急性肾衰竭（ARF），采用腹膜透析（PD）治疗。采用逻辑回归分析来检查与PD相关并发症的危险因素，并比较ARF患者和非ARF患者在控制潜在混杂因素后的死亡率。共有27名（20.8%）患者记录了43例与PD相关的并发症。8名（6.2%）患者出现主要并发症，仅2名（1.5%）患者因肠穿孔并发腹膜炎和半结肠切除术后转为血液透析。PD并发症的主要危险因素是PD持续时间、高RACHS-1评分（先天性心脏病手术风险调整分类）和PD开始时的高钾血症。总体而言，住院死亡率为6.8%（76/1128）。ARF患者的死亡率为20.0%，而非ARF患者为5.0%（调整后的优势比=1.91，95%置信区间=1.10-3.36）。分层后，在总体死亡风险最低的亚组患者（年龄≥1岁、体重≥5kg、RACHS-1评分<3且术前无发绀）中，ARF与死亡率增加密切相关。对于死亡风险高的患者（年龄<1岁、体重<5kg、RACHS-1评分≥3、体外循环时间≥60分钟且术前发绀），ARF与死亡率之间的关联明显较弱。总之，先天性心脏病手术患儿术后ARF与死亡率增加相关。PD的主要并发症很少，我们的数据有力地支持PD是治疗儿童ARF的一种简单、安全、可行且可靠的透析方式。
