Published April 2017
JAMA Pediatrics

When infants receive heart surgery, fluid overload after the procedure can present high risks of morbidity and mortality.

Fluid overload can impair lung function and reduce cardiac output. Meanwhile, imbalances in electrolyte levels present potentially fatal arrhythmia risks.

Traditionally, clinicians have administered diuretic medications to control post-operative fluid build-up. However, this study led by cardiac and kidney experts at Cincinnati Children’s reports that using peritoneal dialysis (PD) is more effective.

The study involved 73 infants who received intravenous furosemide (1 mg/kg every 6 hours) or a standardized PD regimen after cardiac surgery. No difference was found between the PD and furosemide groups in the incidence of negative fluid balance on the first postoperative day. However, the furosemide group was three times more likely to have 10 percent fluid overload. They were more likely to require prolonged ventilator use, longer duration of inotrope use. They also showed higher electrolyte abnormality scores.

“This study reveals that early PD is a superior method of fluid management with a very low risk for adverse events and is associated with less-prolonged mechanical ventilation, fewer inotropic requirements, and fewer electrolyte abnormalities,” says the study’s lead author David Kwiatkowski, MD, MS, a former fellow at Cincinnati Children’s now practicing at Stanford University.

While some concerns have been raised about the cost of dialysis, this study cites previous research establishing that PD expenditures are offset by decreased resource use, thus resulting in unchanged costs yet improved outcomes.

“Use of PD should be strongly considered among infants at high risk for postoperative acute kidney injury and fluid overload,” says senior author, David Morales, MD.