Prophylactic postoperative peritoneal dialysis in neonatal cardiac critical care: a matched retrospective cohort study.

Abstract

Objective: Postoperative prophylactic peritoneal dialysis after paediatric cardiac surgery has been reported with mixed results. We aimed to describe a large cohort of patients who did and did not receive prophylactic peritoneal dialysis following cardiac surgery in our institution.

Methods: Single-centre, retrospective matched-cohort study of patients 0-30 days old who underwent cardiac surgery between 01/2015 and 05/2022. Patients who received prophylactic peritoneal dialysis were matched 1:1 with those who did not by age, sex, and surgical complexity. The objective of the study was to compare the prevalence of postoperative severe acute kidney injury by Kidney Disease Improving Global Outcomes criteria between patients who received prophylactic peritoneal dialysis and those that did not. The significance level was set at p = 0.05.

Results: A total of 224 patients underwent prophylactic peritoneal dialysis, and 224 did not. Patients in the prophylactic postoperative peritoneal dialysis group had a lower incidence of severe acute kidney injury (13.4% versus 30.4%, p < 0.001). Fluid balance in the first 24 hours and 48 hours postoperatively was lower (p < 0.001), and time to negative fluid balance was shorter in the prophylactic postoperative peritoneal dialysis group (p < 0.001). Utilising adjusted multivariable logistic regression, we report no association between the use of prophylactic postoperative peritoneal dialysis and the development of severe acute kidney injury (p = 0.504).

Conclusion: In this large cohort of patients, we report that patients who underwent prophylactic postoperative peritoneal dialysis, although they had an improved fluid balance during the first 48 postoperative hours, had no association with the development of severe acute kidney injury.