Supplemental information for Early Peritoneal Dialysis and Postoperative Outcomes in Infants after Paediatric Cardiac Surgery: Systematic Review & Meta-analysis
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1 cardiovascular surgery/ or exp heart surgery/
2 cardiopulmonary bypass/
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5 time factor/
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7 (surger* or surgical* or repair).tw,kw,hw,fs. and (cardiac or heart).tw,kw,hw.
8 (newborn* or neonat* or infan* or baby or babies or pre-schooler* or preschooler* or boy*1 or girl*1 or child or children or childhood or adolescen* or pediatric* or paediatric* or youth* or teen or teens or teenage*).af.
4425812
9 (time or timing or early or prophyla*).tw,kw,hw.
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2 Peritoneal Dialysis/
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4 Cardiopulmonary Bypass/
5 Thoracic Surgery/
6 (time or timing or early or prophyla*).tw,kf,hw.
7 (newborn* or neonat* or infan* or baby or babies or pre-schooler* or preschooler* or boy*1 or girl*1 or child or children or childhood or adolescen* or pediatric* or paediatric* or youth* or teen or teens or teenage*).af.
3946105 8 time factors/
9 (1 or 3 or 4 or 5) and 2 and (6 or 8) and 7 10 limit 9 to yr="1981 -Current"
PubMed
(heart OR cardiac OR thoracic OR cardio OR cardiopulmonary OR cardio-pulmonary OR cardiothoracic OR cardio-thoracic) AND (surger* OR surgical* OR repair OR bypass OR norwood) AND (“peritoneal dialysis” OR
“peritoneal catheter” OR “peritoneal catheters”) AND (time OR timing OR early OR prophyla*) AND (newborn*
OR neonat* OR infan* OR baby OR babies OR pre-schooler* OR preschooler* OR boy OR boys OR girl OR girls OR child OR children OR childhood OR adolescen* OR pediatric* OR paediatric* OR youth* OR teen OR teens OR teenage*) AND (NOTNLM OR publisher[sb] OR inprocess[sb] OR pubmednotmedline[sb] OR
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Appendix table 1. Overall and domain level risk of bias assessments for selected studies
Study Domain level risk of bias Overall risk
of bias
No Author, year, (country) ref
Pre-
intervention - bias due to confounding
Pre-
intervention- bias in selection of participants
Intervention- bias in classification of
intervention
Post-intervention- bias due to deviation from intended interventions
Post-
intervention- bias due to missing data
Post-
intervention- bias in measurement of outcomes
Post-
intervention- bias in selection of reported result 1 Bojan, 2012,
(Paris, France)1
Moderate Moderate Low Moderate Low Moderate Moderate Moderate risk
2 Saini, 2012, (Michigan, USA)2
Critical Critical Moderate No information Low Serious Serious Critical risk
3 Sasser, 2014,
(Birmingham, USA)3 Critical Moderate Serious No information Low Serious Serious Critical risk
4 Kwiatkowski, 2015, (Cincinnati, USA)4
Critical Serious Moderate No information Low Moderate Moderate Critical risk
5 Sanchez-de-Toledo, 2016, (Barcelona, Spain)5
Critical Critical Critical No information Moderate Serious Serious Critical risk
6 Kwiatkowski, 2017, (Cincinnati, USA)6
Low Moderate Low Low Low Low Moderate Moderate risk
7 Pan, 2018, (Beijing, China)7
Serious Moderate Moderate Moderate Moderate Serious Moderate Serious risk
8 Namachivayam, 2020, (Melbourne, Australia)8
Moderate Moderate Moderate Moderate Low Moderate Moderate Moderate risk
9 Gist, 2021, (Colorado, USA)9
Serious Moderate Moderate Moderate Moderate Serious Moderate Serious risk
Risk of bias assessment was made using Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool10
Appendix table 2. Clinical outcomes in studies of early peritoneal dialysis included in the meta-analysis No Author, year,
(country) ref Enrolment period, design,
(methodology)
Sample size (Early PD vs control)
PD catheter:
(1) Place of insertion (2) Indication for PD use in Early PD group
PD regime Surgical complexity Factors controlled in study
Clinical outcome (Early PD vs control)
1 Bojan, 2012, (Paris, France)1
2000-2009 Observational, (Propensity score)
Early PD: 109 Control: 37
(1) OT and ICU (2) Fluid overload, oliguria/anuria, low cardiac output, acid- base disturbance
1 hourly cycle 10-20 ml/kg, 2.27-3.86 % dextrose dialysate
Surgical complexity (Basic Aristotle score
>8) in 73%
Age, cross clamp duration, DHCA, ultrafiltration, ECMO postop, creatinine clearance at PD initiation
MV: 12.2 (9.1) vs 18.6 (14.0) ICU stay: 17.8 (11.8) vs. 25.2 (17.9) Hospital stay: NK
2 Kwiatkowski, 2017, (Cincinnati, USA)6
2011-2015
RCT Early PD: 41
Control: 32 (1) OT
(2) Randomised to PD 1 hourly cycle 10ml/kg, 1.5%
dextrose dialysate
Median (IQR) RACHS-1 score 4 (3- 4)
None MV: 3 (1.5) vs 4 (3.1)
ICU stay: 8.3(4.61) vs. 9.7(7.7) Hospital stay: 15(9.9) vs 17.7(14) 3 Pan, 2018,
(Beijing, China)7 2010-2015 Observational, (Propensity score)
Early PD: 45
Control: 45 (1) OT for early PD group (2) Based on pre- existing high risk, fluid overload criteria
1 hourly cycle 10ml/kg, 2.5%
& 4.25%
dextrose dialysate
All participants with RVOT obstructive lesions$
Age, Weight, CPB duration, surgeon, VIS at admission, RVP/LVP ratio at end of surgery
MV: 2.46 (2.10) vs 4.12 (3.54) ICU stay: 4.6 (2.3) vs 7 (3.8) Hospital stay: NK
4 Namachivayam, 2020, (Melbourne, Australia)8
2012-2015 Observational, (Propensity score)
Early PD: 56
Control: 183 (1) OT
(2) Prophylactic early use
1 hourly cycle 10ml/kg, 1.5%
dextrose dialysate
RACHS-1 category 1&2: 11%
3&4: 76%
5&6: 13%
Age, Weight, CPB duration, RACHS-1 category, serum lactate on admission
MV: 3.53(2.79) vs 4.80(4.80) ICU stay: 5.98(5.42) vs 7.68(7.02) Hospital stay: 20.07(17.45) vs 19.71(16.07)
5 Gist, 2021,
(Colorado, USA)9 2010-2016
Observational Early PD: 25
Control: 16 (1) ? OT
(2) Prophylactic early use
1 hourly cycle 10ml/kg, dextrose concentration titrated
All participants in RACHS-1 category 3 (Transposition of Great Arteries with Intact Ventricular Septum)
Age, open chest, lowest preop creatinine, CPB duration, diuretic use, hospital location
MV: 1.82(0.8) vs 2.75(0.93) ICU stay: 6.3 (3.9) vs 10.4 (4.9) Hospital stay: 9.5(3.1) vs 11.9 (5.7)
For study no 2, 3 and 5 mean (SD) for MV, ICU stay and hospital stay were calculated using formula provided by Wan et al11 For study no 4, mean (SD) was not reported in the original manuscript and was obtained from primary authors.
NK, not known; PD, Peritoneal dialysis; MV: Mechanical ventilation; ICU: Intensive care unit; RCT, Randomised controlled trial; OT: Operating theatre; DHCA: deep hypothermic circulatory arrest; ECMO: extracorporeal membrane oxygenation; RACHS-1: Risk adjustment for congenital heart surgery-1; CPB: cardiopulmonary bypass; VIS: vasoactive- inotropic score; RVP/LVP: Right ventricular pressure to left ventricular pressure ratio; $RVOT obstructive lesions included tetralogy of Fallot, pulmonary artery atresia and ventricular septal defect and the double-outlet right ventricle with pulmonary stenosis
References
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2. Saini A, Delius RE, Seshadri S, Walters H, 3rd, Mastropietro CW. Passive peritoneal drainage improves fluid balance after surgery for congenital heart disease. Eur J Cardiothorac Surg 2012;41:256-60.
3. Sasser WC, Dabal RJ, Askenazi DJ, et al. Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes. Congenit 2014;9:106-15.
4. Kwiatkowski DM, Menon S, Krawczeski CD, et al. Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 2015;149:230-6.
5. Sanchez-de-Toledo J, Perez-Ortiz A, Gil L, et al. Early Initiation of Renal Replacement Therapy in Pediatric Heart Surgery Is Associated with Lower Mortality. Pediatr Cardiol 2016;37:623-8.
6. Kwiatkowski DM, Goldstein SL, Cooper DS, Nelson DP, Morales DL, Krawczeski CD. Peritoneal Dialysis vs Furosemide for Prevention of Fluid Overload in Infants After Cardiac Surgery: A Randomized Clinical Trial.
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8. Namachivayam SP, Butt W, Millar J, Konstantinov IE, Nguyen C, d'Udekem Y. Early Peritoneal Dialysis and Major Adverse Events After Pediatric Cardiac Surgery: A Propensity Score Analysis. Pediatr Crit Care Med 2019;20:158-65.
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10. Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919.
11. Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014;14:135.