Real-World Testing of a Clinical Strategy to Start Early Peritoneal Dialysis for High-Risk Newborns after Cardiac Surgery.

KEY POINTS

Inability to achieve negative fluid balance in postoperative 24 hours may be a reliable surrogate marker to start early peritoneal dialysis (PD) after cardiac surgery. Prolonged cardiopulmonary bypass and aorta cross-clamp duration may determine PD catheter placement in the operating room. The first postoperative 8 hours was indiscriminative for the decision to start early PD for these high-risk newborns.

BACKGROUND

The beneficial effect of peritoneal dialysis (PD) catheter placement after cardiopulmonary bypass (CPB) in young infants has been demonstrated. However, the indications to start early PD are not agreed upon.

METHODS

This retrospective single-center study was conducted to evaluate the performance of a clinical strategy for early PD start. PD catheters were placed in the operating room after CPB. Those with prolonged CPB times (>180 minutes), postoperative (postop) oligoanuria, and/or inability to achieve negative fluid balance in postop 24 hours were evaluated as high risk and selected for early PD (PD [+]) start. All PD (+) were started within the first postop 24 hours. Primary outcomes were 5% fluid accumulation at postop 48 hours and severe AKI on postop day (POD) 5.

RESULTS

There were 49 newborns. Twenty-nine newborns were early PD (+) starts, and 20 used the PD catheter as an abdominal drain (PD −). Baseline demographic data were similar. Both groups were oliguric during first postop 8 hours ( = 0.906). The early PD (+) group produced significantly less urine output during POD 1 (0.98 versus 3.02 ml/kg per hour; = 0.001). At postop 48 hours, the early PD (+) group had a similar prevalence of 5% fluid accumulation as early PD (−): 5 (16.7%) versus 2 (7.41%), respectively ( = 0.427). Severe AKI incidence on POD 5 was similar between the groups (17.3% versus 5.0%; = 0.204). Time to extubation was longer for the early PD (+) group compared with the PD (−) group: 10.0 days (7.0–16.0) versus 4.0 days (4.0–10.0), respectively ( = 0.017).

CONCLUSIONS

Persistent oliguria and inability to achieve negative fluid balance during initial postop 24 hours may identify those newborns who will benefit from early PD. The first postop 8 hours was indiscriminative for this strategy. PD start may ameliorate the disadvantage for the designated group.