The Risk Factors Of Acute Kidney Injury And Application Of Peritoneal Dialysis After In Children With Congenital Heart Disease

Objective:The purpose of this study was to analyze the risk factors for acute kidney injury (AKI) after congenital heart surgery in children using the pediatric RIFLE (pRIFLE) score and to investigate the effect of peritoneal dialysis (PD) in AKI following the cardiac surgery in children.Methods:In total,234 children (≤12 years old) who underwent the cardiac surgery in our hospital from Jan 2008 to Dec 2012 were enrolled in this research, including 10 children of AKI treated by PD after surgery by using Foley catheter to replace PD catheter. The patients were divided into non-AKI group and AKI group by the RIFLE criteria (pRIFLE). The incidence of AKI and the clinical characteristics of patients who required PD were observed. And the preoperative, intraoperative and postoperative variables were compared between the non-AKI group and the AKI group. Preoperative and intraoperative variables were analyzed by univariate and multivariate logistic regression analysis to find out the risk factors of AKI following the cardiac surgery.Results:The incidence of AKI following the cardiac surgery was 28.6%(67/234). We found that there were significant differences(P<0.05) between the non-AKI group and the AKI group about age, weight, preoperative serum creatinine, cardiopulmonary bypass time, aortic clamping time, postoperative mechanical ventilation time,24-hour fluid overload after surgery, the proportion of postoperative inotropic drug use, hospitalization time. Multivariate logistic regression analysis showed that low weight and prolonged cardiopulmonary bypass time were independent risk factors for AKI.The cohort of 10 PD children had an average PD time of 87.4 hours, an average 24-h our dialysis ultrafiltration after PD of 25.7 ml/h. Two patients died because of low cardia c output syndrome. One patient died of multiple organ failure. The other 7 patients’clini cal variables, including the serum creatinine, serum urea nitrogen, blood PH, base excess, urine, ultra filtration volume, returned to normal after positive PD treatment and were di scharged. And dialysate leakage occurred in two children. None of them developed perito nitis, haemorrhage or dialysate poor drainage.Conclusions:AKI is common after cardiac surgery in children, with high incidence and mortality. Low weight and prolonged cardiopulmonary bypass time are independent risk factors of AKI in these patients. PD is a safe and effective method to treat AKI after surgery in children with congenital heart disease, the Foley catheter may be used as the PD catheter.