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Renal replacement therapy in the pediatric cardiac intensive care unit.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2019 Nov; Vol. 158 (5), pp. 1446-1455. Date of Electronic Publication: 2019 Jul 10. - Publication Year :
- 2019
-
Abstract
- 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.<br />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.<br />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).<br />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.<br /> (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Child
Female
Hospital Mortality
Humans
Infant
Intensive Care Units, Pediatric statistics & numerical data
Male
Organism Hydration Status
Postoperative Complications physiopathology
Retrospective Studies
Risk Assessment
Risk Factors
United States epidemiology
Acute Kidney Injury etiology
Acute Kidney Injury physiopathology
Acute Kidney Injury therapy
Cardiovascular Surgical Procedures adverse effects
Cardiovascular Surgical Procedures classification
Cardiovascular Surgical Procedures mortality
Heart Defects, Congenital surgery
Postoperative Complications therapy
Renal Replacement Therapy adverse effects
Renal Replacement Therapy methods
Renal Replacement Therapy mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 158
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 31395365
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2019.06.061