ArticlePediatric cardiology2026
Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the United States.
Article in Pediatric cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Hemodialysis after infant congenital heart surgery (CHS) for acute kidney injury (AKI) presents a major challenge due to relatively low utilization, difficult vascular access and small patient size. Therefore, we performed a multi-institutional analysis for infants requiring hemodialysis post-CHS. The Pediatric Health Information System (PHIS) was queried for infants undergoing CHS from 2004 to 2024. Intermittent hemodialysis (iHD) and continuous renal replacement therapy (CRRT) were included, patients undergoing pre-CHS dialysis or post-CHS peritoneal dialysis during admission were excluded. High HD use centers were in the top 10% of HD usage while low HD use centers were all other centers. After CHS, 1% (332/31,634) of infants received a form of hemodialysis (HD); 61% (204/332) received CRRT, 11% (37/332) received iHD, 11% (36/332) received both, and 17% (55/332) had an unknown type. HD was provided in 2% (220/12,898) of neonates (< 31days-old at CHS) vs. 1% (112/18,736) of infants 31-365 days old (p < 0.001). One-year survival was lower in the dialysis vs. non-dialysis cohort (46% vs. 94%, p < 0.0001). CRRT patients had higher one-year survival vs. iHD (50% vs. 25%, weighted log-rank; p = 0.01), although there was no difference after adjustment upon multivariate analysis. HD infants at high HD use centers had improved hospital and 1-year survival vs. low HD use (66% vs. 23%; 67% vs. 28%, p < 0.0001). Infants requiring hemodialysis (iHD or CRRT) post-CHS suffer from poor outcomes with < 50% 1-year survival, with high HD use centers having triple the hospital survival and double the 1-year survival, suggesting modifiable factors may mitigate poor outcomes.
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