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

Elvia Rivera-Figueroa; Md Abu Yusuf Ansari; Emily Turner Mallory; Padma Garg; Mary B Taylor; Ali Mirza Onder

doi:10.34067/KID.0000000691

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

Kidney360. 2025 Jan 8. doi: 10.34067/KID.0000000691. Online ahead of print.

Authors

Elvia Rivera-Figueroa^{1

2}, Md Abu Yusuf Ansari³, Emily Turner Mallory⁴, Padma Garg¹, Mary B Taylor¹, Ali Mirza Onder^{5

6}

Affiliations

¹ Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, MS.
² Division of Pediatric Critical Care, Puerto Rico Women's and Children's Hospital, Ponce Health Sciences University, Bayamon, Puerto Rico.
³ Department of Data Science, University of Mississippi Medical Center, Jackson, MS.
⁴ University of Mississippi, Medical School, Jackson, MS.
⁵ Division of Pediatric Nephrology, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, MS.
⁶ Division of Pediatric Nephrology, Nemours Children's Health, Wilmington, DE.

PMID: 39774669
DOI: 10.34067/KID.0000000691

Abstract

Background: The beneficial impact of peritoneal dialysis (PD) catheter placement following cardiopulmonary bypass in young infants has been demonstrated. But the indications to start early peritoneal dialysis 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 (OR) following cardiopulmonary bypass (CPB). Those with prolonged CPB times (>180 minutes), post-operative (post-op) oligo-anuria and/or inability to achieve negative fluid balance in post-op 24 hours were evaluated as high-risk and selected for early PD start (PD +). All PD + were started within the first post-op 24 hours. Primary outcomes were 5% fluid accumulation at post-op 48 hours and severe acute kidney injury (AKI) at post-op day 5.

Results: There were forty-nine newborns. Twenty-nine subjects were early PD (PD +) starts and twenty used the PD catheter as an abdominal drain (PD -). Baseline demographic data were similar. Both groups were oliguric during post-op first 8 hours (p= 0.906). The Early PD (+) group produced significantly less urine output during post-op day 1 (0.98 vs 3.02 ml/kg/hour; p= 0.001). At post-op 48 hours, early PD (+) group had similar prevalence of 5% fluid accumulation as early PD (-), 5 (16.7%) vs. 2 (7.41%), respectively (p= 0.427). Severe AKI incidence at post-op day 5 was similar between the groups (17.3% vs 5.0%; p=0.204). Time to extubation was longer for early PD (+) group compared to PD (-) group, 10.0 days [7.0;16.0] vs. 4.0 days [4.0;10.0] (p=0.017).

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