The usage of ambulatory peritoneal dialysis as a renal replacement therapy after open cardiac surgery

Acute renal injury and renal failure development is a serious complication following cardiovascular surgery.Age, preoperative renal disease, diabetes, hypertension and low left ventricular ejection fraction increase the risk of renal function impairment. Despite the renal and hemodynamic support strategies, acute renal failure still has an increased morbidity and mortality.Renal replacement therapy is needed when there is a life-threathing risk of impaired renal functions. Intermittent hemodialysis, ambulatory peritoneal dialysis and continuous hemofiltration could be choosed for renal replacement therapy. Objective of this study is to evaluate the usage and outcome of peritoneal dialysis as a renal replacement therapy.This is a retrospective analysis of the patients who underwent open heart surgery between 2003 and 2011.We had choosen 19 patients who were scheduled for postoperative ambulatory peritoneal dialysis and were catheterizated during the operation. Data were obtained from the patients' files as well as from our cardiac surgery database.There were 11 male and 8 female postoperative cardiac patients. The average of the patients age was 66 years. Thirteen of these patients had coronary artery bypass grafting, 3 of them had coronary artery bypass grafting and heart valve surgery, 1 patient had heart valve surgery, 1 patient had coronary artery bypass grafting and aortoplasty, 1 patient had coronary artery bypass grafting and heart valve surgery plus an excision of left ventricular mass. Fourteen of these patients had chronic renal failure. The average creatinine level were 4,75mg/dl. The average of MDRD-GFR was 18,68 mL/dk/1,73m2 and EF is %51,11. According to EUROSCORE levels, 1 patient's score was low, 5 of them were moderate, 13 of them were high.The postoperative peritoneal dialysis had started immediately in the surgical intensive care unit. Two patient had died of multiple organ failure. One patient had been taken to the operation room because of bleeding complications. Two patient had bleeding complications of the peritoneal catheter. One patient had pleural effusion and 1 patient had pleural effusion and peritonitis.When the patients were discharged from the hospital, 11 patient had ambulatory peritoneal dialysis and 1 patient had intermittent hemodialysis. Five patient's ambulatory peritoneal dialysis therapy had been ended and those patients did not need any renal replacement therapy.According to our results, the patients who had preoperative MDRD-GFR value lower than 20 mL/min./1.73m2 had to go on renal replacement therapy. However the patients who had preoperative MDRD-GFR value higher than 20 mL/min./1.73m2 did not need any long term renal replacement therapy.When we compare the results of our study with the case series in the literature, ambulatory peritoneal dialysis therapy could be an acceptable renal replacement therapy option following cardiac surgery. Patients who underwent open heart surgery, ambulatory peritoneal dialysis therapy might be a secure medical therapy for the patients who are clinically suitable, who have any risk for acute renal failure and postoperative renal replacement therapy and also who have adequate social/family support. However more large clinical studies on this issue are needed in order to compare any clinical available data.Keywords: acute renal failure, open heart surgery, ambulatory peritoneal dialysis therapy