Renal Replacement Therapy in Pediatric Cardiac Intensive Care: A Retrospective Analysis of Modalities, Outcomes, and Prognostic Factors.

Background: Acute kidney injury (AKI) frequently complicates the postoperative course in pediatric patients after cardiac surgery and may necessitate renal replacement therapy (RRT). Despite the increasing use of RRT in this population, data on its modalities, outcomes, and prognostic factors remain limited. Methods: This retrospective cohort study included 37 children (aged 2 days-14 years) who underwent RRT in a cardiac intensive care unit (CICU) over a 35-month period. Modalities used were continuous veno-venous hemodiafiltration (CVVHDF) and peritoneal dialysis (PD). Results: The overall mortality was 76%, with no significant difference between RRT modalities. CVVHDF was used in 84% of cases, often during ECMO support. PD was more common in neonates and low-weight infants. Fluid overload and anuria were the leading indications. Survivors were older and heavier. Technical parameters, including blood flow, dialysis dose, and anticoagulation method, were not associated with survival. Conclusions: RRT in pediatric CICU patients is associated with high mortality, independent of modality. Early identification and appropriate patient selection may improve outcomes.