Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Institute of Pediatric Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Thorac Cardiovasc Surg. 2014 Jan;147(1):451-5. doi: 10.1016/j.jtcvs.2013.03.032. Epub 2013 Apr 30.
Available data on the long-term renal outcome of patients who required renal replacement therapy after cardiac surgery for correction of congenital cardiac anomalies are scarce. The aim of the present study was to investigate the long-term renal prognosis of children treated with peritoneal dialysis after surgical correction of congenital heart anomalies.
The present single-center cohort study was based on clinical data from patients who underwent surgery for the correction of congenital heart disease between 1996 and 2004 at the Schneider's Children's Medical Center of Israel, and developed acute kidney injury (AKI) requiring peritoneal dialysis. Perioperative risk factors were analyzed. Survivors were followed up for 3.5 to 10.5 years after their surgery. Renal function was assessed in survivors by physical examination, including blood pressure, growth evaluation, urinalysis, glomerular filtration rate estimated from plasma creatinine using the Schwartz formula, and ultrasonographic examination of the kidneys.
There were 2994 children who underwent surgery during the study period. Eighty-four children (2.84%) developed postoperative AKI that was managed with peritoneal dialysis. Seventy-six children were included in our study, 8 were excluded because of a lack of complete data. Of the 76 children included, 35 died during the immediate postoperative period, 15 died during the interim of nonrenal causes, and 26 were alive at the time of follow-up evaluation. Twenty-five patients with a complete evaluation had blood pressure measurements in the normal range. Plasma creatinine levels were normal for age. Only 1 child, who had a pre-existing congenital renal anomaly, had an abnormal glomerular filtration rate. None of the children had proteinuria. Three children were treated with angiotensin-converting enzyme inhibitors and 2 were treated with furosemide for congestive heart failure. We found no risk factors associated with immediate postoperative death.
Despite the development of AKI requiring dialysis after surgical correction of congenital cardiac anomalies, the long-term renal prognosis in survivors is good.
心脏手术纠正先天性心脏畸形后需要肾脏替代治疗的患者的长期肾脏预后数据有限。本研究旨在探讨接受先天性心脏畸形手术后接受腹膜透析治疗的儿童的长期肾脏预后。
本单中心队列研究基于 1996 年至 2004 年在以色列施耐德儿童医疗中心接受手术治疗先天性心脏病的患者的临床数据，这些患者发生了需要腹膜透析的术后急性肾损伤（AKI）。分析围手术期危险因素。术后幸存者随访 3.5 至 10.5 年。幸存者的肾功能通过体格检查评估，包括血压、生长评估、尿液分析、基于血浆肌酐的 Schwartz 公式估计肾小球滤过率和肾脏超声检查。
研究期间共有 2994 例儿童接受手术。84 例（2.84%）患儿术后发生 AKI，接受腹膜透析治疗。本研究共纳入 76 例患儿，8 例因资料不全被排除。在纳入的 76 例患儿中，35 例在术后即刻死亡，15 例因非肾脏原因在中期死亡，26 例在随访评估时存活。25 例完成评估的患儿血压测量值在正常范围内。血浆肌酐水平与年龄相符。仅 1 例存在先天性肾脏异常的患儿肾小球滤过率异常。无患儿出现蛋白尿。3 例患儿接受血管紧张素转换酶抑制剂治疗，2 例患儿因充血性心力衰竭接受呋塞米治疗。我们未发现与术后即刻死亡相关的危险因素。
尽管在先天性心脏畸形手术后发生需要透析的 AKI，但幸存者的长期肾脏预后良好。
