Acute Kidney Injury After Surgery for Congenital Heart Disease

Aydin, Scott I.; Seiden, Howard; Blaufox, Andrew D.; Parnell, Vincent; Choudhury, Tarif; Punnoose, Ann R.; Schneider, James

doi:10.1016/j.athoracsur.2012.06.050

Cited by 139 publications

(153 citation statements)

References 28 publications

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“…43% of our patients met criteria for AKI. Consistent with prior studies, a majority met criteria within 48hREP [2, 3, 9]. Thus, AKI was likely CPB-related and not secondary to later post-surgical complications.…”

Section: Discussionsupporting

confidence: 74%

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Kim‐Campbell

Gretchen

Callaway

et al. 2017

Critical Care Medicine

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Objective To determine the relationship between the production of cell-free plasma hemoglobin (PHb) and acute kidney injury (AKI) in infants and children undergoing cardiopulmonary bypass (CPB) for cardiac surgery. Design Prospective observational study Setting 12-bed cardiac ICU in a university-affiliated children’s hospital Patients Children were prospectively enrolled during their pre-operative outpatient appointment with the following criteria: >1month to <18 years old, procedures requiring CPB, no preexisting renal dysfunction. Interventions None Measurements and Main Results Plasma and urine were collected at baseline (in a subset), the beginning and end of CPB, and 2h and 24h after CPB in 60 subjects. Levels of PHb increased during CPB and were associated (p<0.01) with CPB duration (R2=0.22), depletion of Hp at end and 24h after CPB (R2=0.12 and 0.15, respectively), LDH levels at end CPB (R2=0.27), and change in creatinine (R2=0.12). 43% of patients developed AKI. There was an association between PHb level and change in creatinine that varied by age (overall [R2=0.12, p<0.01], in age >2yrs [R2=0.22, p<0.01], and in <2yrs [R2=0.03, p=0.42]). Change in PHb and male gender were found to be risk factors for AKI (OR 1.02 and OR 3.78, p<0.05). Conclusions Generation of PHb during CPB and male gender are associated with subsequent renal dysfunction in low risk pediatric patients, especially in those >2yrs of age. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing CPB would benefit from potential treatments for hemolysis and PHb-associated renal dysfunction.

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Section: Discussionsupporting

confidence: 74%

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Kim‐Campbell

Gretchen

Callaway

et al. 2017

Critical Care Medicine

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“…Several investigators have begun to explore risk factors for the development of AKI and its implications for children undergoing congenital heart surgery 3,4,8,9 ; data are sparse regarding the relationship between specific surgical procedures and AKI. Patients undergoing Fontan completion comprise an appealing study population from which to improve our understanding of AKI.…”

mentioning

confidence: 99%

Acute kidney injury after Fontan completion: Risk factors and outcomes

Esch

Salvin

Thiagarajan

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Acute kidney injury (AKI) is a predictor of outcomes in heterogeneous populations of children undergoing cardiac surgery. We investigated its causes and consequences in a cohort undergoing Fontan completion, hypothesizing that central venous pressure is independently associated with development of AKI.Methods: In this retrospective cohort study of patients undergoing Fontan (n ¼ 211), univariable and multivariable analyses identified factors associated with AKI within 3 days of surgery. Secondary analyses identified factors associated with hospital length of stay, and examined effects of perioperative kidney injury on follow-up renal function.Results: Acute kidney injury occurred in 42% of cases (n ¼ 89), with the following independent risk factors: mean renal perfusion (mean arterial minus central venous) pressure on postoperative day zero (per mm Hg; adjusted odds ratio [AOR] 0.83; P < .001); preoperative atrioventricular valve regurgitation > mild (AOR 6.78; P ¼ .02); bypass time (per 10 minutes, AOR 1.08; P ¼ .04); peak inotrope score on postoperative day zero (per point, AOR 1.17; P < .001); and preoperative pulmonary vascular resistance (per Wood unit, AOR 1.69; P ¼ .04). Central venous pressure was not independently associated with AKI. Moderate and severe (but not mild) AKI were independently associated with prolonged hospital length of stay (adjusted hazard ratios, 0.56; P ¼ .004, and .41; P ¼ .006, respectively). Perioperative injury was not associated with longer-term renal dysfunction.Conclusions: Acute kidney injury is common after Fontan completion and has several potentially modifiable risk factors. Moderate-to-severe injury is associated with longer hospital length of stay but not with renal dysfunction at follow-up. (J Thorac Cardiovasc Surg 2015;150:190-7) Effect of acute kidney injury on length of stay after Fontan completion. Central MessageAcute kidney injury is common after Fontan completion, and moderate-to-severe AKI predicts longer hospital length of stay. Injury seems to be mediated more by systemic hypotension than by central venous hypertension. Maintaining postoperative renal perfusion pressure while moderating inotrope use might reduce risk of injury and thus length of stay. PerspectiveAcute kidney injury in adults undergoing cardiac surgery is strongly associated with adverse outcomes. The importance of cardiac surgery-associated AKI in children is less clear. Patients undergoing Fontan completion face an acute rise in renal venous pressure and thus comprise an appealing model population. Acute kidney injury is common after the Fontan procedure, and moderate-to-severe AKI predicts longer hospital length of stay. Lower renal perfusion pressure and higher peak inotrope score are independent risk factors for AKI, whereas higher central venous pressure is not. This study provides important insight on the pathophysiology of AKI, and suggests strategies to mitigate AKI in this population.

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“…Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass (CPB), 1,2 and is independently associated with adverse outcomes, including longer lengths of stay (LOSs), prolonged mechanical ventilation, and higher mortality. 3,4 Early identification of patients at risk for developing AKI may allow implementation of strategies to reduce related morbidity and mortality.…”

Section: What This Study Addsmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

et al. 2015

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OBJECTIVES: To examine the relationship of cardiac biomarkers with postoperative acute kidney injury (AKI) among pediatric patients undergoing cardiac surgery.METHODS: Data from TRIBE-AKI, a prospective study of children undergoing cardiac surgery, were used to examine the association of cardiac biomarkers (N-type pro-B-type natriuretic peptide, creatine kinase-MB [CK-MB], heart-type fatty acid binding protein [h-FABP], and troponins I and T) with the development of postoperative AKI. Cardiac biomarkers were collected before and 0 to 6 hours after surgery. AKI was defined as a $50% or 0.3 mg/dL increase in serum creatinine, within 7 days of surgery. RESULTS:Of the 106 patients included in this study, 55 (52%) developed AKI after cardiac surgery. Patients who developed AKI had higher median levels of pre-and postoperative cardiac biomarkers compared with patients without AKI (all P , .01). Preoperatively, higher levels of CK-MB and h-FABP were associated with increased odds of developing AKI (CK-MB: adjusted odds ratio 4.58, 95% confidence interval [CI] 1.56-13.41; h-FABP: adjusted odds ratio 2.76, 95% CI 1.27-6.03). When combined with clinical models, both preoperative CK-MB and h-FABP provided good discrimination (area under the curve 0.77, 95% CI 0.68-0.87, and 0.78, 95% CI 0.68-0.87, respectively) and improved reclassification indices. Cardiac biomarkers collected postoperatively did not significantly improve the prediction of AKI beyond clinical models.CONCLUSIONS: Preoperative CK-MB and h-FABP are associated with increased risk of postoperative AKI and provide good discrimination of patients who develop AKI. These biomarkers may be useful for risk stratifying patients undergoing cardiac surgery.WHAT'S KNOWN ON THIS SUBJECT: Acute kidney injury (AKI) occurs in up to 50% of children after cardiopulmonary bypass and is associated with adverse outcomes. Renal biomarkers have been shown to predict postoperative AKI, but few studies have examined cardiac biomarkers for risk classification.WHAT THIS STUDY ADDS: Preoperative levels of creatine kinase-MB and heart-type fatty acid binding protein are strongly associated with the development of postoperative AKI after pediatric cardiac surgery and can be used to improve preoperative clinical risk prediction.

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Acute Kidney Injury After Surgery for Congenital Heart Disease

Cited by 139 publications

References 28 publications

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Acute kidney injury after Fontan completion: Risk factors and outcomes

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

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