157 Continuous Renal Replacement Therapy After Cardiac Surgery in Children

Objective: To study the evolution of children requiring continuous renal replacement therapy (CRRT) after cardiac surgery and to analyse factors associated with mortality. Material and methods: Prospective observational study between 1996 and 2009 in children after cardiac surgery requiring CRRT. Univariate and multivariate analysis were performed to analyse the influence of each factor on mortality. Results: Of the 1650 post-operatory cardiac surgery patients admitted in the ICU between 1996 and 2009, 81(4,9%) required CRRT. 26% weighed less than 5 kg. Patients with CRRT after cardiac surgery had a mean arterial pressure, creatinine and urea at the beginning of the CRRT, significantly lower than other critically ill children with CRRT, and they needed mechanical ventilation more frequently. There were no significant differences in the mortality risk scores PRISM, PIM y PELOD. Mortality of patients with CRRT after cardiac surgery was higher 43% than the mortality of the rest of patients 29% (p=0,051). Factors associated with mortality were age less than 12 months, weight less than 10 kg, hypotension, high PRIMS score and low creatinine and urea at the beginning of the CRRT, and hemofiltration (without dialysis). In the multivariate study the only factor associated with mortality was the hypotension at the beginning of CRRT (Hazard Ratio: 4.01; CI 95%:1.2-13.4; p=0.024). Conclusions: A 5 % of children after cardiac surgery require CRRT. Mortality of these patients is higher than other critically ill children who require CRRT. Hypotension at the beginning of the CRRT is the most important factor related to mortality.