Pediatric Peritoneal Dialysis after Cardiopulmonary Bypass: Long-Term Outcomes

Background: Acute kidney injury (AKI) with fluid overload is a common complication for children undergoing congenital heart surgery and is associated with increased mortality and extended length of hospital stays (LOS). We and others have demonstrated early initiation of peritoneal dialysis (PD) in the post-operative period is associated with decreased fluid accumulation, ICU LOS and mortality. Since 2010, our institution developed a systems-wide practice to electively place PD catheters at the time of cardiopulmonary bypass (CPB) surgery in a child deemed to be at high risk for AKI. Although outcomes for these patients are often excellent, there has been no investigation into the outcomes of patients who continue to require PD beyond AKI. We aimed to further understand the outcomes our population in order for providers to better counsel families on goals on care. Methods: This is a retrospective cohort study of patients aged birth to 18 years deemed at risk for AKI who received placement of a PD catheter in the OR after CPB between 2018 and 2023. Results: 342 patients received a PD catheter over the study period. 112 (33%) had continuous PD for a median time of 2 days (IQR 1-5 days, range 1-157 days). 9/112 (8%) of these patients required PD for >14 days. Of these 9 patients, 5/9 survived until CICU discharge and 4/9 survived until hospital discharge. 2/4 patients who survived until hospital discharge never recovered kidney function. 1/8 patients survived until a year after PD initiation, with an additional patient surviving, but currently only 11 months old. 5/9 patients became tracheostomy and ventilator dependent, 2/9 remained intubated until time of death, and 2/9 were discharged home with low flow nasal cannula oxygen supplementation. Conclusion: The requirement of PD for >14 days was associated with more than 50% in-hospital mortality, poor respiratory outcomes, and 1-year survival less than 25%. Despite the excellent clinical outcomes we have observed for patients receiving PD in the post-operative AKI period, patients who require PD for prolonged courses appear to have poor clinical outcomes and may need different care counseling.