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Ann Thorac Surg 2004;77:61-65
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery

Harald Boigner, MDa*, Werner Brannath, PhDb, Michael Hermon, MDa, Elisabeth Stoll, MDa, Gudrun Burda, MDa, Gerhard Trittenwein, MDa, Johann Golej, MDa

a Department of Neonatology and Pediatric Intensive Care, University Children's Hospital of Vienna, Vienna, Austria
b Institute of Medical Statistics, University of Vienna, Vienna, Austria

Accepted for publication July 29, 2003.

* Address reprint requests to Dr Boigner, Department of Neonatology and Pediatric Intensive Care, University Children's Hospital of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
e-mail: harald.boigner{at}akh-wien.ac.at

BACKGROUND: The development of renal dysfunction in the postoperative course of cardiac surgery is still associated with high mortality in pediatric patients. In particular for small infants peritoneal dialysis offers a secure and useful treatment option. The aim of the present study was to investigate if routinely used laboratory and clinical variables could help predict mortality at initiation of peritoneal dialysis.

METHODS: We performed a retrospective chart analysis of pediatric intensive care unit patients with renal dysfunction who were treated with peritoneal dialysis after cardiac surgery between 1993 and 2001 and analyzed variables obtained 3 hours or less before starting peritoneal dialysis.

RESULTS: Results are documented as means and standard errors. A total of 1,141 children underwent a cardiac operation on cardiopulmonary bypass. Sixty-two children (5.4%) were treated with peritoneal dialysis. Mortality was 40.3% (37 survivors, 25 nonsurvivors). The pH in survivors was 7.35 (0.01); in nonsurvivors it was 7.23 (0.03; p = 0.0037). Base excess in survivors was -1.37 mmol/L (0.61); in nonsurvivors it was -7.17 mmol/L (1.49; p = 0.0026). Lactate in survivors was 4.5 mmol/L (0.60); in nonsurvivors it was 10.5 mmol/L (1.78; p = 0.0089). Positive inspiratory pressure in survivors was 24.6 cmH2O (0.78); in nonsurvivors it was 28.9 cmH2O (1.08; p = 0.0274). Tidal volume per kilogram bodyweight in survivors was 11.0 mL/kg (0.48); in nonsurvivors it was 8.7 mL/kg (0.50; p = 0.0493).

CONCLUSIONS: We conclude from our data that the consideration of pH, base excess, lactate, positive inspiratory pressure, and tidal volume per kilogram bodyweight help predict mortality at initiation of peritoneal dialysis. We were able to observe significant differences between survivors and nonsurvivors using these variables.






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