Acute Kidney Injury in Children Undergoing Surgery for Congenital Heart Disease

Pedersen, Kirsten

doi:10.1055/s-0032-1322540

“…8 However, pRIFLE may have lower specificity in the case of severe kidney injury. Nevertheless, most AKI patients in the present study developed only mild kidney injury and all patients had nearly fully recovered prior to discharge.…”

Section: Variables Affecting Aki Severitymentioning

confidence: 99%

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

Lee

¹

,

Kim

²

,

Kim

³

et al. 2017

Circ J

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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.

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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%

“…5,6 Preliminary evidence suggests that biomarkers can help to identify patients at risk for postoperative AKI. 2 In both pediatric and adult populations, renal biomarkers, such as serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL), have been shown to predict postoperative AKI and improve risk classification when combined with other clinical models. [7][8][9][10][11] In addition, studies in adults have shown that pre-and postoperative levels of cardiac biomarkers, such as B-type natriuretic peptide (BNP), strongly predict postoperative AKI risk.…”

Section: What This Study Addsmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Bucholz

¹

,

Whitlock

²

,

Zappitelli

³

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 (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%

“…5,6 Preliminary evidence suggests that biomarkers can help to identify patients at risk for postoperative AKI. 2 In both pediatric and adult populations, renal biomarkers, such as serum cystatin C and neutrophil gelatinase-associated lipocalin (NGAL), have been shown to predict postoperative AKI and improve risk classification when combined with other clinical models. [7][8][9][10][11] In addition, studies in adults have shown that pre-and postoperative levels of cardiac biomarkers, such as B-type natriuretic peptide (BNP), strongly predict postoperative AKI risk.…”

Section: What This Study Addsmentioning

confidence: 99%

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

2015

PEDIATRICS

0

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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 in Children Undergoing Surgery for Congenital Heart Disease

Cited by 20 publications

References 64 publications

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

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

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

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Acute Kidney Injury in Children Undergoing Surgery for Congenital Heart Disease

Cited by 20 publications

References 64 publications

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

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

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Cardiac Biomarkers and Acute Kidney Injury After Cardiac Surgery

Contact Info

Product

Resources

About

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

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