Renal replacement therapy in the pediatric cardiac intensive care unit

J Thorac Cardiovasc Surg. 2019 Nov;158(5):1446-1455. doi: 10.1016/j.jtcvs.2019.06.061. Epub 2019 Jul 10.


Objective: There is an increased risk of mortality in patients in whom acute kidney injury and fluid accumulation develop after cardiothoracic surgery, and the risk is especially high when renal replacement therapy is needed. However, renal replacement therapy remains an essential intervention in managing these patients. The objective of this study was to identify risk factors for mortality in surgical patients requiring renal replacement therapy in a pediatric cardiac intensive care unit.

Methods: We performed a retrospective review of patients requiring renal replacement therapy for acute kidney injury or fluid accumulation after cardiothoracic surgery between January 2009 and December 2017. Survivors and nonsurvivors were compared with respect to multiple variables, and a multivariable logistic regression analysis was performed to identify independent risk factors associated with mortality.

Results: The mortality rate for the cohort was 75%. Nonsurvivors were younger (nonsurvivors: 0.8 years; interquartile range, 0.1-8.2; survivors: 14.6 years; interquartile range, 4.2-19.7; P = .002) and had a lower weight-for-age z-score (nonsurvivors: -1.5; interquartile range, -3.1 to -0.4; survivors: -0.5; interquartile range, -0.9 to 0.3; P = .02) compared with survivors. There was no difference with respect to fluid accumulation. In multivariable analysis, a longer duration of stage 3 acute kidney injury before initiation of renal replacement therapy was independently associated with mortality (adjusted odds ratio, 1.39; 95% confidence interval, 1.05-1.83; P = .021).

Conclusions: Mortality in patients requiring renal replacement therapy after congenital heart disease surgery is high. A longer duration of acute kidney injury before renal replacement therapy initiation is associated with increased mortality.

Keywords: acute kidney injury; congenital heart disease; renal replacement therapy.

MeSH terms

  • Acute Kidney Injury* / etiology
  • Acute Kidney Injury* / physiopathology
  • Acute Kidney Injury* / therapy
  • Adolescent
  • Cardiovascular Surgical Procedures* / adverse effects
  • Cardiovascular Surgical Procedures* / classification
  • Cardiovascular Surgical Procedures* / mortality
  • Child
  • Female
  • Heart Defects, Congenital / surgery*
  • Hospital Mortality
  • Humans
  • Infant
  • Intensive Care Units, Pediatric / statistics & numerical data
  • Male
  • Organism Hydration Status
  • Postoperative Complications / physiopathology
  • Postoperative Complications / therapy*
  • Renal Replacement Therapy* / adverse effects
  • Renal Replacement Therapy* / methods
  • Renal Replacement Therapy* / mortality
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • United States / epidemiology