Early peritoneal dialysis after congenital heart surgery in neonates and infants: Survival and metabolic outcomes

BACKGROUND Early peritoneal dialysis (PD) is widely used after congenital heart disease surgery in neonates and infants, but the impact of PD timing on outcomes remains uncertain. METHODS We conducted a retrospective single-center cohort study of neonates and infants who underwent cardiopulmonary bypass surgery between 2015 and 2025 and subsequently required PD. Early PD was defined as initiation within 6 hours postoperatively. The primary outcome was in-hospital mortality. Secondary outcomes included duration of mechanical ventilation, ICU stay, postoperative lactate, creatinine and urea levels, PD-related complications, and time to enteral feeding. Logistic regression evaluated the association between PD timing and mortality, and model performance was summarized using the c-statistic. RESULTS Seventy-nine patients were included, of whom 36 (46%) died. Mortality was higher in the late-PD group than in the early-PD group (22/36 61% vs 14/43 33%). Late PD was associated with increased odds of death in unadjusted analysis (odds ratio 3.26; 95% confidence interval 1.29-8.21; p=0.012) and remained significant after adjustment for surgical complexity and major perioperative covariates (odds ratio 4.96; 95% confidence interval 1.45-16.97; p=0.011). Model discrimination improved with adjustment (c-statistic 0.756). Early PD was associated with faster lactate clearance, whereas ventilation duration, ICU stay, and time to enteral feeding did not differ between groups. PD-related complications occurred in 19%. CONCLUSIONS Early PD was safe, accelerated metabolic recovery, and was independently associated with lower in-hospital mortality compared with later initiation.