Publications

Severe acute kidney injury requiring dialysis complicates approximately 1% of infant congenital heart surgeries, with continuous renal replacement therapy being the predominant modality.[e12117-c1,e12117-c4,e12117-c7] The mortality burden is substantial: one-year survival for dialysis-dependent infants reaches only 46%, compared to 94% for those not requiring renal support.[e12117-c2,e12117-c3] Volume-outcome relationships are pronounced in this rare complication. Centers with higher dialysis utilization demonstrate three-fold improvement in hospital survival and double the one-year survival rates.[e12117-c5,e12117-c6] These data suggest that institutional experience with post-cardiac surgery dialysis—encompassing technical proficiency, hemodynamic management during continuous therapies, and multidisciplinary coordination—directly impacts outcomes. The rarity of the indication creates a natural concentration effect: regionalization or selective referral of dialysis-requiring cases to high-volume centers may be justified, though prospective validation is needed. Current evidence supports early consultation with experienced centers when post-operative AKI progresses toward dialysis thresholds.