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Improved Outcomes with Peritoneal Dialysis vs. Furosemide for Oliguria after Cardiopulmonary Bypass in Infants

Kwiatkowski, David M

Abstract Details

2014, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Background: Acute kidney injury (AKI) is a common complication in infants after heart surgery with cardiopulmonary bypass. Studies demonstrate that patients with AKI have worse clinical outcomes, including prolonged ventilation times and length of stay, likely secondary to fluid overload from oliguria. Studies suggest that early peritoneal dialysis (PD) may be superior management to diuretic medications (furosemide) for oliguria; however, this has not been proven. We aim to determine if early PD improves clinical outcomes compared to furosemide in infants with oliguria after cardiac surgery. We hypothesize that early initiation of PD will improve outcomes. Methods: This was the pilot study for a fully powered single-center randomized clinical trial. Infants with PD catheters placed during bypass were included. If infants demonstrated oliguria within the first postoperative day, they were randomized to either early PD use or furosemide. Clinical and laboratory data were collected and compared between groups. Power calculations were performed using the primary outcome of fluid balance. Results: Data were collected on the first 20 patients who met criteria for randomization; 10 to each arm. Patients in the PD arm had higher likelihood of a negative fluid balance on postoperative day 1 (60 vs 90%), demonstrated negative fluid balance 8 hours earlier (16 vs. 24 hours), were extubated 3 days earlier (3 vs. 6 days), and were transferred from the intensive care unit and hospital 6 days earlier (7 vs. 13 days; 10 vs. 16.5 days) than patients treated with furosemide. No significant adverse outcomes were reported. Using the primary outcome of negative fluid balance on postoperative day 1, a sample size of 32 participants per group was calculated for study completion. Conclusions: The use of peritoneal dialysis for patients with oliguria after heart surgery shows trends towards earlier negative fluid balance, and shorter duration of ventilation and CICU stays. Adverse outcomes were not significant in this limited review. Completion of the fully powered study is necessary to demonstrate causation of outcomes with the use of PD.
Erin Nicole Haynes, Dr. P.H. (Committee Chair)
Catherine Dent Krawczeski, M.D. (Committee Member)
Stuart Goldstein, M.D. (Committee Member)
17 p.

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Citations

  • Kwiatkowski, D. M. (2014). Improved Outcomes with Peritoneal Dialysis vs. Furosemide for Oliguria after Cardiopulmonary Bypass in Infants [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396523170

    APA Style (7th edition)

  • Kwiatkowski, David. Improved Outcomes with Peritoneal Dialysis vs. Furosemide for Oliguria after Cardiopulmonary Bypass in Infants. 2014. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396523170.

    MLA Style (8th edition)

  • Kwiatkowski, David. "Improved Outcomes with Peritoneal Dialysis vs. Furosemide for Oliguria after Cardiopulmonary Bypass in Infants." Master's thesis, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396523170

    Chicago Manual of Style (17th edition)