Acute Kidney Injury Following Cardiopulmonary Bypass in Children　― Risk Factors and Outcomes ―

Abstract

Background: Acute kidney injury (AKI) is the most common and most serious complication following heart surgery. We aimed to determine the prevalence of, and risk factors for, AKI following pediatric cardiac surgery. Methods and Results:We retrospectively analyzed 135 patients aged ≤18 years who underwent cardiac surgery for congenital heart defects; by RACHS-1 category, 58 patients (43%) had an operative risk score ≥3. AKI was defined and classified using the pediatric pRIFLE criteria (Pediatric Risk, Injury, Failure, Loss, and End-stage Kidney Disease); 19 patients (14.1%) developed AKI: 17 had AKI with a severity classified as risk (R) and 2 had AKI classified as injury (I). Body weight, height, body surface area, and preoperative mechanical ventilation were all independently associated with AKI development (P=0.038, 0.040, 0.033 and 0.008, respectively). Preoperative ventilation strongly correlated with AKI severity. Higher pRIFLE classification positively correlated with increased incidence of peritoneal dialysis, increased postoperative mechanical ventilation duration, and longer hospital stay (P=0.009, 0.039 and 0.042, respectively). Conclusions:In this study, we found a low prevalence of postoperative AKI in pediatric patients undergoing severe cardiac surgery. AKI was associated with worse early postoperative outcomes. Early prediction and appropriate treatment of AKI during the postoperative period are emphasized.

Acute kidney injury after pediatric cardiac surgery

“…As indicated by Ricci et al, 26 according to pRIFLE criteria, the incidence of postoperative AKI was 50% in those receiving fenoldopam and 72% in those receiving placebo. Lee et al 29 reported that this incidence was 14.1% in 19 patients: 17 had AKI Stage Risk (R) and 2 had AKI Injury (I). However, the incidence increased to 90% in the children after ECMO initiation.…”

Development of acute kidney injury following pediatric cardiac surgery

“…Li et al [2] found that those with a preoperative mean weight of 2.4 kg developed AKI more frequently than those who had a preoperative weight of 19 kg. A retrospective analysis performed by Lee et al [16] demonstrated similar results; lower mean preoperative weight was associated with increased incidence of AKI. In addition, Lee et al [16] found preoperative mechanical ventilation to be associated with AKI.…”

“…A retrospective analysis performed by Lee et al [16] demonstrated similar results; lower mean preoperative weight was associated with increased incidence of AKI. In addition, Lee et al [16] found preoperative mechanical ventilation to be associated with AKI.…”

“…The effect of baseline creatinine on development of AKI in the pediatric cardiac surgery patient population is still uncertain [14]. [14] Increased AKI in neonates Sethi et al [15] Age < 12 months independent risk factor Park et al [4] Age < 12 months independent risk factor Lower weight Li et al [2] Increased AKI in lower weight cohort Lee et al [16] Lower preoperative weight associated with AKI RACHS- 1 Blinder et al [14] Higher RACHS-1 score associated with AKI Li et al [2] No association between RACHS-1 score and AKI Lee et al [16] No association between RACHS-1 score and AKI Intraoperative Use of CPB Mao et al [18] Increased incidence of AKI with use of CPB Blood transfusion Nadim et al [17], Mao et al [18] Increased incidence of AKI with blood transfusions Intraoperative hypotension Kanji et al [19] Change Finally, there is some evidence that the complexity of cardiac surgery being performed, gauged by the RACHS-1 score, or risk-adjusted classification for congenital heart surgery, plays a role in the development of AKI, as seen by Blinder et al [14]. However, other studies have shown that RACHS-1 was not a significant factor in the development of AKI.…”

Paucity of renal follow-up by school age after neonatal cardiac surgery

“…In children, the rate of cardiac surgery-associated acute kidney injury is highest in neonates, and it is known to be associated with hospital mortality and morbidity. [2][3][4][5][6] In adults, cardiac surgery-associated acute kidney injury is associated with new onset or progression of chronic kidney disease, and non-recovery from cardiac surgery-associated acute kidney injury prior to hospital discharge increases this risk. [7][8][9] Several studies have evaluated the association of cardiac surgery-associated acute kidney injury in children and have revealed conflicting results.…”