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MINERVA UROLOGICA E NEFROLOGICA

A Journal on Nephrology and Urology


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  XVI CONGRESS DELLA SOCIETÀ ITALIANA DI NEFROLOGIA SEZIONE PIEMONTE-VALLE D’AOSTA
Castello di Rivoli, Rivoli (TO) October 10, 1998


Minerva Urologica e Nefrologica 2000 September;52(3):115-7

language: Italian

Treatment of acute renal failure and fluid overload after cardiopulmonary bypass with peritoneal dialysis

Gianoglio B., Amore A., Bonaudo R., Porcellini M. G., Peruzzi L., Conti G., Bianco R., Santoro G., Abruzzese P., Coppo R.

Azienda Ospedaliera OIRM-S. Anna - Torino Divisione di Nefrologia Divisione di Cardiochirurgia


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Background. Infants undergoing cardiac surgery with prolonged cardio-pulmonary bypass are particularly exposed to the risk of acute renal failure for renal hypoxia due to low cardiac output.
Methods. To limit fluid overload deriving from oligo-anuria and low cardiac output we have recently adopted an early peritoneal dialysis protocol, positioning the peritoneal catheter during the intervention and performing early exchanges at first signs of inadequate diuretic response and/or “leaky capillary syndrome” with diffuse edema. From 1-1 to 31-12-1997 12 patients (8 males), of median age of 65,5 days (range 1-350 days) and median weight of 3463 g (range 2380-6550 g) were treated with peritoneal dialysis (automated exchanges of 10 ml/kg body weight of 1.5 % glucose, dwell time 20 minutes). Cardiac pathologies included complex hearth malformations. Cardiopulmonary bypass lasted a mean of 202 minutes (range 102-372 minutes). The children were treated for a minimum of 1 to 42 peritoneal dialysis sessions. The infusional therapy included human albumin and fresh frozen plasma to substitute losses and furosemide at the dose of 4 mg/kg/day to reduce the “leaky capillary syndrome”.
Results. The results were very satisfactory: only 3 children died in the first 30 days after surgery. Renal function was normal at the end of the observation in 8/12 cases, and 2 cases presented chronic renal failure.
Conclusions. Since similar series report a mortality rate of 33-79%, it is suggested that early peritoneal dialysis may have positively influenced the final survival rate.

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