Infographic: Practice Patterns and Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the United States

Infographic · May 2026 · 1 min read

In brief

Study examines outcomes for infants requiring hemodialysis after congenital heart surgery, finding 46% one-year survival versus 94% for those not needing dialysis. Hospitals with higher dialysis volume demonstrated three times better hospital survival and double the one-year survival, suggesting experience-dependent factors may improve outcomes in this high-risk population.

Only 1% of infants post-cardiac surgery require hemodialysis, but mortality is severe: 54% die within one year vs 6% without dialysis.
High-volume hemodialysis centers achieve triple the hospital survival (66% vs 23%) and double the 1-year survival (67% vs 28%) for these infants.
CRRT shows better unadjusted 1-year survival than intermittent HD (50% vs 25%), though difference disappears after risk adjustment.
Neonates under 31 days are twice as likely to need post-operative hemodialysis compared to older infants (2% vs 1%).
Center experience with infant hemodialysis appears modifiable: outcomes suggest volume-dependent expertise significantly impacts survival.

Written by the GCMD Library team from the infographic.

The infographic uses a teal header with heart illustration, followed by alternating colored sections (magenta, teal, coral) highlighting key findings. A computer icon represents the database source, and a cartoon illustration of an infant receiving dialysis appears in the lower right. The layout flows from study design at top to conclusions at bottom.

Grant Chappell, Darren Turner, Amir Mehdizadeh-Shrifi, David Lehenbauer, Marco Ricci, Meghan M Chlebowski, Stuart L Goldstein, Awais Ashfaq, David L S Morales

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.

The text in the image

Practice Patterns & Outcomes of Hemodialysis in Infants Undergoing Congenital Heart Surgery in the U.S. | Multi-institution Analysis | Pediatric Health Information System | 2004-2024 | 31,634 infants undergoing congenital heart surgery (CHS) | 332 (1%) received hemodialysis post-op | 204 received continuous renal replacement therapy (RRT) | Neonates <31 days at surgery had 2x the dialysis rate vs. older infants (p<0.001) | High hemodialysis use centers achieved 3x the hospital survival & 2x the 1-year survival | Avoid: delay in RRT initiation when stage 3 acute kidney injury persists >48 hours | conventional adult hemodialysis machines in infants <8kg | 1-year survival | Dialysis cohort: 46% vs. Non-dialysis cohort: 94% | Conclusion: Infants treated at centers experienced with dialysis survive much more often, suggesting that specialized care, early RRT, and multidisciplinary care improves outcomes. | https://pubmed.ncbi.nlm.nih.gov/41511517/ | Chappell G et. al. | Department of Cardiothoracic Surgery, Cincinnati Children's Hospital and Medical Center, USA | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's