Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study

Abstract

Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (<12 months) [odds ratio (OR), 4.01; 95% confidence interval (CI), 1.77–9.06], longer cardiopulmonary bypass (CPB) time (OR, 2.45; 95% CI, 1.24–4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07–5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23–19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33–20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery.

The effect of 6% hydroxyethyl starch (130/0.4) on acute kidney injury in paediatric cardiac surgery: a prospective, randomised trial

“…However, the incidence of postoperative AKI is between 27% and 50% , with a 20–79% mortality . Known AKI risk factors after paediatric cardiac surgery are: young age; surgical complexity; prolonged cardiopulmonary bypass times; and reduced pre‐operative haemoglobin level . Data regarding the effect of a new colloid solution, 6% HES 130/0.4 (Volulyte ® , Fresenius Kabi GmbH, Bad Homgurg, Germany) on AKI after paediatric cardiac surgery are limited.…”

Factors that influenced undergoing renal replacement therapy and survival in children with acute kidney injury

“…Rustagi et al have reported that younger age is a significant risk factor for AKI in critically ill children . Park et al and Tanyıldız et al have found very recently that patients younger than 12 months of age are more likely to have AKI after congenital cardiac surgery . Loza et al showed that among the paediatric patients with AKI, infant age group is associated with increased mortality .…”

Risk factors of acute kidney injury in children after cardiac surgery

“…In addition to preoperative serum albumin level, age <12 months, CPB time, and preoperative pulmonary hypertension were also independent risk factors for AKI after pediatric cardiac surgery. Younger age is known to be a predictor of AKI in children . Park et al demonstrated that age <1 year was a risk factor for AKI after cardiac surgery, and according to Li et al, children aged ≥2 year had a 72% lower likelihood of AKI after cardiac surgery.…”