Renal replacement therapy in neonates with congenital heart disease

Stefano Morelli, Zaccaria Ricci, Luca Di Chiara, Giulia V. Stazi, Angelo Polito, Vincenzo Vitale, Chiara Giorni, Claudia Iacoella, Sergio Picardo

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Background: The acute renal failure (ARF) incidence in pediatric cardiac surgery intensive care unit (ICU) ranges from 5 to 20% of patients. In particular, clinical features of neonatal ARF are mostly represented by fluid retention, anasarca and only slight creatinine increase; this is the reason why medical strategies to prevent and manage ARF have limited efficacy and early optimization of renal replacement therapy (RRT) plays a key role in the outcome of cardiopathic patients. Methods: Data on neonates admitted to our ICU were prospectively collected over a 6-month period and analysis of patients with ARF analyzed. Indications for RRT were oligoanuria (urine output less than 0.5 ml/kg/h for more than 4 h) and/or a need for additional ultrafiltration in edematous patients despite aggressive diuretic therapy. Results: Incidence of ARF and need for RRT were equivalent and occurred in 10% of admitted neonates. Eleven patients of 12 were treated by peritoneal dialysis (PD) as only RRT strategy. PD allowed ultrafiltration to range between 5 and 20 ml/h with a negative balance of up to 200 ml over 24 h. Creatinine clearance achieved by PD ranged from 2 to 10 ml/min/1.73m2. We reported a 16% mortality in RRT patients. Conclusion: PD is a safe and adequate strategy to support ARF in neonates with congenital heart disease. Fluid balance control is easily optimized by this therapy whereas solute control reaches acceptable levels.

Original languageEnglish
Title of host publicationContributions to Nephrology
Pages428-433
Number of pages6
Volume156
DOIs
Publication statusPublished - 2007

Publication series

NameContributions to Nephrology
Volume156
ISSN (Print)03025144

ASJC Scopus subject areas

  • Nephrology

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