Clinical Evaluation and Outcomes of Peritoneal Dialysis Pediatric Cases with Congenital Heart Disease

Abstract

The progress achieved in cardiac and vascular surgery in recent years has allowed not only to increase the number of operations, but also to successfully correct complex congenital heart defects, previously considered inoperable or performed in isolated cases. However, to date, the percentage of postoperative complications remains quite high, primarily due to the development of acute heart failure in the immediate postoperative period due to the severity of the underlying pathology and the scope of the operation itself. Complex reconstructive surgeries are often associated with the need for prolonged artificial circulation, which frequently causes the development of post-perfusion complications in vital organs and systems (heart, lungs, kidneys, brain, blood coagulation system, etc.). In particular, acute renal failure (ARF), according to a number of authors, is observed in 3-5% of children undergoing heart surgery. Prolonged artificial circulation, a decrease in perfusion rates in some cases, and unstable hemodynamics in the intraoperative and/or postoperative period often cause a decrease in glomerular blood flow (normally 25% of the CBV), which leads to a decrease in glomerular filtration and impaired tubular function and, ultimately, to acute renal failure. The principles of treating ARF are based on restoring renal function, temporarily replacing the impaired organ function, and symptomatic therapy. Pathogenetic treatment should be aimed at improving glomerular blood flow and filtration. This can be achieved by achieving adequate circulating blood volume and renal perfusion through the use of diuretics, inotropic drugs, and correct infusion therapy. However, the use of diuretics against the background of morphofunctional changes in the renal tubules often does not produce the desired effect. Furthermore, the concentrating capacity of the renal tubules in newborns and infants is reduced due to the functional immaturity of renal tissue, and the body is not adapted to excrete large amounts of fluid. The use of inotropic drugs improves myocardial contractility and, in certain doses, renal perfusion. However, an increase in their concentration often leads to a decrease in renal blood flow due to a direct adrenergic effect on the alpha receptors of the afferent arteriole. It is extremely important that, under conditions of tissue hyperhydration, it is virtually impossible to provide the required volume of infusion therapy and ensure adequate compensation for energy losses due to the risk of volume overload and, consequently, disturbances in cardiac hemodynamics and gas exchange.