Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Abstract

Objective: Determine the risk factors for repeated episodes of acute kidney injury (AKI) in children who undergo multiple cardiac surgical procedures Design: Single center retrospective chart review Setting: Cardiac intensive care unit at a quaternary pediatric care center Patients: Birth to 18 years who underwent at least 2 cardiac surgical procedures with cardiopulmonary bypass. Interventions: None Measurements and Main Results: 180 patients underwent 2 cardiac surgical procedures and 89 underwent 3. AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. AKI incidence was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most AKI occurring on post-operative days 1 and 2. The proportion of patients with severe AKI increased from surgery 1 to surgery 3. Patients with AKI had a significantly longer duration of ventilation and length of stay after each surgery. The odds of AKI after surgery 3 was 2.40 times greater if AKI was present after surgery 1 or 2 (95% CI: 1.26 to 4.56, p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with AKI (p = 0.85). Conclusions: In a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of AKI after a third surgery was

Comparison of creatinine and cystatin C for estimation of glomerular filtration rate in pediatric patients after Fontan operation

“…A recent study by Hasson et al looked at a heterogeneous population of pediatric congenital heart disease patients undergoing multiple surgeries. In their cohort, odds of acute kidney injury after a third surgery was 2.4 times more likely if they had an acute kidney injury after either of the first 2 surgeries . There is a high prevalence of chronic kidney disease in the adult Fontan population with over 50% of patients having reduced glomerular filtration rate or microalbuminuria .…”

Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children

“…The inability to quantify hourly urine output after furosemide may reflect the higher urine flow rate in patients with stage 3 versus stage 2 AKI. It is known that a single episode of AKI lowers the reserve for a subsequent episodes, 19 and increases CKD risk. 20,21 Any efforts to mitigate or reduce the severity of AKI (i.e., avoidance of nephrotoxic medications) 22 could be implemented by assessing urine flow rate following furosemide.…”

The Year in Review: Anesthesia for Congenital Heart Disease 2019

“…22 Hasson et al were interested in risk factors for recurrent AKI in children undergoing multiple cardiac surgeries. 23 Given the increasing number of children undergoing multiple cardiac surgeries, especially for single ventricle palliation, it is warranted for clinicians to understand the risk factors for adverse outcomes in these children. This was a retrospective study of 180 children younger than 18 years who underwent at least 2 cardiac surgeries, with 89 going on to have a third operation.…”

“…The investigators found that AKI after the first or second surgery was independently associated with increased relative risk of AKI after a third surgery (2.40 [95% CI ¼ 1.26-4.56]; P ¼ .008). 23 Interestingly, several patients had AKI after surgeries 1 and 3, but not the second surgery. 23 The authors hypothesized that this might be related to a report demonstrating short-term maladaptive hyperfiltration after recurrent AKI.…”

“…23 Interestingly, several patients had AKI after surgeries 1 and 3, but not the second surgery. 23 The authors hypothesized that this might be related to a report demonstrating short-term maladaptive hyperfiltration after recurrent AKI. 24 Anesthesiologist taking care of these children must recognize that patients returning to the operating room for subsequent surgeries may be at increased risk for AKI.…”