Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Piggott, Kurt D.; Soni, Meshal; DeCampli, William M.; Ramirez, Jorge A.; Holbein, Dianna; Fakioglu, Harun; Blanco, Carlos; Pourmoghadam, Kamal

doi:10.1177/2150135115586814

Cited by 73 publications

(54 citation statements)

References 25 publications

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“…Higher RACHS category was found to be associated with AKI by Piggott et al; however in the current study this was not found to be significant. 22 Even though AKI tends to occur more commonly in procedure with higher RACHS score and higher Aristotle score. Younger age has been associated with higher risk of AKI in previous reports; no significant difference could be found in the study.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11]17,21 We found prolonged CPB time to be associated with higher odds of developing AKI which was consistent with previous studies. [9][10][11]21,22 The possible reason of longer CPB time associated with AKI is multifactorial and probably due to the physiological alternation occurring during CPB. 20 In the study higher AXC time was found to be significantly associated with AKI.…”

Section: Discussionmentioning

confidence: 99%

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Acute kidney injury as a predictor of poor outcome post cardiopulmonary bypass in children

Alam

Akunuri

Hegde

et al. 2016

Int J Contemp Pediatr

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Background: We objective of the current study was to identify the prevalence of AKI and classify them based on Acute Kidney Injury Network (AKIN) staging system. We also evaluated the outcome of patients developing AKI and identified the associated risk factors.Methods: This retrospective study was conducted in pediatric cardiac ICU of a tertiary care hospital. Patient < 18 years who underwent cardiac surgery on cardiopulmonary bypass (CPB) for congenital heart disease were enrolled in the study. AKI was defined as increase in serum creatinine ≥ 0.3 mg/dl within 48 hours or 1.5 times or more from baseline within the first 7 days post-surgery. Results: Nine hundred and twenty children were enrolled in the study. Three hundred and twelve (34%) children developed AKI with 202 (20%) developing stage I, 92 (10%) stage II and 18 (2%) stage III. Resolution was achieved in all the patients and none developed chronic kidney disease. Risk factors for AKI were higher CPB time, higher aortic cross clamp time, significant arrhythmias and higher inotropic requirement at admission. Children with stage 2 and 3 disease had higher odds for requirement of mechanical ventilation > 24 hours and > 72 hours, length of ICU stay > 5 days and in hospital mortality. Conclusions: AKI following cardiac surgery is common. Although majority of the cases are mild disease and self-limiting it can significantly affect the outcome of these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute kidney injury as a predictor of poor outcome post cardiopulmonary bypass in children

Alam

Akunuri

Hegde

et al. 2016

Int J Contemp Pediatr

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“…More importantly, pediatric CS-AKI has been consistently associated with a number of complications including increased morbidity and mortality in this population. In the short term, after adjustment for covariates, pediatric CS-AKI is independently associated with longer duration of ventilation, longer intensive care unit and hospital stay, increased inotropic support, increased occurrence of low cardiac output syndrome, and increased mortality [1,3,12–19]. In the long term, severe pediatric CS-AKI is independently associated with increased mortality [3,15], lower z-score for height [15], as well as evidence for chronic kidney disease [20].…”

Section: Incidence and Etiology Of Cardiac Surgery-associated Acutmentioning

confidence: 99%

Early detection of acute kidney injury after pediatric cardiac surgery

Jefferies

Devarajan

2016

Progress in Pediatric Cardiology

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Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy.

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“…Postoperative acute kidney injury (AKI) in pediatric patients is a serious complication associated with adverse outcomes including prolonged mechanical ventilation, prolonged hospital stay, and high morbidity and mortality [1–7]. Previous studies have reported that younger age [1, 3, 4, 7], prematurity [4, 6], longer cardiopulmonary bypass (CPB) time [2–4, 6, 7], a high Risk Adjusted Classification of Congenital Heart Surgery (RACHS-1) score [1, 7], longer vasopressor use [3] and selective cerebral perfusion [8, 9] are associated with CS-AKI in infants and children. Recently, several plasma and urine biomarkers reflecting renal injury have been investigated to facilitate early diagnosis [10–12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Abstract: To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound.

Cited by 73 publications

References 25 publications

Acute kidney injury as a predictor of poor outcome post cardiopulmonary bypass in children

Acute kidney injury as a predictor of poor outcome post cardiopulmonary bypass in children

Early detection of acute kidney injury after pediatric cardiac surgery

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

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