Renal Replacement Therapy after the correction of complex congenital heart diseases in children

Taking into consideration anatomical and physiological particularities of puerile organism, marked severity and rapid progress of multiorgan failure after cardiac and vascular surgery, the problem of indication and well-timed beginning of RRT becomes a key one and determines the results of treatment in children after cardiac and vascular surgery. The aim of this presentation was the determination of indications and the analysis of the effectiveness of postoperative RRT use in children after heart surgery. The PD method was of used in 139 children, among them - in 53 infants under 1 year of age. Extracorporal methods were used in 23 children, including 5 neonates. The patients’ age varied from 9 days to 16 years, the weight - from 2,9 to 48 kg. The course of early postoperative period in all patients was complicated by the development of MOF syndrome. The main indications for the beginning of PD were, above all, in the development of oligoanuria, hypervolemia, and edema syndrome with progressing cardiac and respiratory failure. After 4-5 days of complex intensive care, which included PD, we have noticed significant positive dynamics in clinical state of 66% of the children. The survival rate in the studied group was 37%, renal function was restored in all those patients. Negative daily fluid balance was achieved in 100% of cases with HDF use. Already during the first hours of the procedure we noticed a reliable decrease of the level of central venous pressure and PLA pressure within the limits of 10-15% with parallel increase of mean arterial pressure and LVEF; it allowed to decrease significantly the dosage of cardiotonics by the end of the procedure. In this study RRT allowed to stabilize the increase of azotemia and then - to decrease its level in all the patients. Mortality rate in the studied group of patients was 63%, with no lethal outcome being directly related to the complication of RRT and the progressing of renal failure and was most likely caused by the increase of other system dysfunction.

кардиохирургические операции, искусственное кровообращение, дети, врожденные пороки сердца, острая почечная недостаточность, интенсивная терапия, заместительная почечная терапия, перитонеальный диализ, гемодиафильтрация

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