Acute Kidney Injury in Pediatric Cardiac Intensive Care Children: Not All Admissions Are Equal: A Retrospective Study

Ricci, Zaccaria; Raggi, Valeria; Marinari, Eleonora; Vallesi, Leonardo; Chiara, Luca Di; Rizzo, Caterina; Gist, Katja M.

doi:10.1053/j.jvca.2021.04.015

Cited by 7 publications

(8 citation statements)

References 32 publications

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“…We will enlarge our sample size to further explore the optimal blood glucose thresholds for postoperative renal function according to different age gaps. Thirdly, though the incidence of AKI in our study is consistent with that in a previous study diagnosing AKI solely according to serum creatinine [46], it is probable that some additional AKI would have been identified when combined with the urine output KDIGO criteria. Lastly, this was a single-center observational study, some confounding factors were unavoidable, which might affect the final results.…”

Section: Limitationssupporting

confidence: 89%

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Bie,

Wang,

Zhang

et al. 2023

Congenital Heart Disease

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Purpose: This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury (AKI) in children undergoing congenital cardiac surgery. Methods: We conducted a prospective nested case-control study in children (age < 18 years) undergoing congenital heart surgery with cardiopulmonary bypass (CPB) at the Fuwai Hospital between April 01, 2022 and July 30, 2022. Cases were individuals who developed AKI within the first postoperative 7 days (AKI group) and controls were those without AKI (Non-AKI group) according to KDIGO criteria. AKI and Non-AKI groups unmatched and 1:1 matched by age, sex, and baseline serum creatinine were separately analyzed. Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI. Results: 688 consecutively approached patients were included in the final analysis. On multivariate analysis, intra-CPB (adjusted odds ratio [OR] 0.802; 95% confidence interval [CI], 0.706 to 0.912; p = 0.001) and post-CPB (adjusted OR 0.830; 95% CI, 0.744 to 0.925; p = 0.001) blood glucose levels were associated with postoperative AKI. There were no significant differences in pre-CPB blood glucose (adjusted OR 0.926; 95% CI, 0.759 to 1.129; p = 0.446) or intraoperative glycemic fluctuations (adjusted OR 0.905; 95% CI, 0.723 to 1.132; p = 0.382) between AKI and Non-AKI groups. Results based on matched cases and controls were consistent with those from the unmatched analyses. Conclusion: Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

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Section: Limitationssupporting

confidence: 89%

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Bie,

Wang,

Zhang

et al. 2023

Congenital Heart Disease

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“…Several other factors lead to renal dysfunction in these patients. Nephrotoxic drugs, infections, contrast agents, and excessive fluid administration can worsen CRS 3,15 . Developing AKI in cardiac patients, even in minor degrees, can cause adverse complications, such as higher mortality rates, prolonged hospital admission, and hemodynamic instability 16–18 .…”

Section: Introductionmentioning

confidence: 99%

“…The survival of patients with congenital heart diseases has increased dramatically due to recent advances in cardiac surgery, yet morbidity rates remain high 1,2 . Acute kidney injury (AKI), defined as an abrupt decline in renal function, is a common complication in critically ill patients admitted to the pediatric cardiac intensive care unit (PCICU) 3,4 . Studies show a wide range of AKI prevalence in patients, from 4.5% in developed countries to 58% in developing countries 5–8 ; different AKI definitions can also contribute to this variation 9–12 .…”

Section: Introductionmentioning

confidence: 99%

Prevalence, risk factors, and outcomes of acute kidney injury in a pediatric cardiac intensive care unit: A cross‐sectional study

Esmaeili,

Asgarian,

Aghaei Moghadam

et al. 2024

Health Science Reports

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Background and AimsAcute kidney injury (AKI) is a common complication in pediatric cardiac intensive care unit (CICU). This study aims to identify the prevalence, risk factors, and outcomes of AKI in pediatrics admitted to a CICU unit of a tertiary hospital.MethodsWe retrospectively gathered the data of 253 randomly selected patients admitted to the CICU unit from March 2018 to March 2022. Data were collected from EHRs. We used the Kidney Disease Improving Global Outcomes (KDIGO) criteria for identifying AKI in patients.ResultsOverall, AKI prevalence was 22.9% in our population. In the multivariable analysis, vancomycin intake (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.15–3.84), angiography (OR: 4.38, 95% CI: 1.28–14.93), and mechanical ventilation (OR: 2.08, 95% CI: 1.02–4.23) were independent risk factors of AKI development and patients with AKI had a higher in‐hospital mortality rate (OR: 5.81, 95% CI: 2.55–13.19), higher need for cardiopulmonary resuscitation (OR: 3.08, 95% CI: 1.17–8.09), and longer ICU length of stay (OR: 6.49, 95% CI: 3.31–9.67). Furthermore, furosemide administration was associated with lower risk of developing AKI (OR: 0.52, 95% CI: 0.27–0.97).ConclusionAKI is common and is associated with worse outcomes in patients with congenital heart disease. Our results emphasize the importance of early identification and monitoring of AKI in the pediatric CICU setting.

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“…This increased attention has led to advancements in our comprehension of normal and abnormal kidney development, AKI mechanisms, characterization and consequences of AKI, and interventions which seek to alleviate the burden of AKI on patients [1 && ]. AKI is common in pediatric patients; rates are approximately 20%, 30% and 40-60% in neonatal intensive care units (NICU), pediatric intensive care units (PICU) and cardiac intensive care units (CICU), respectively [2][3][4][5][6]. Although AKI was previously considered limited and self-resolving, research over the past two decades has demonstrated the long-term toll of pediatric AKI, including an increase in mortality, morbidity, and resource utilization [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Adults are just big kids: pediatric considerations for adult critical care nephrology

Starr,

Gilley,

See

et al. 2023

Current Opinion in Critical Care

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Purpose of review In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician. Recent findings We summarize what is known in the field of pediatric AKI to inform adult medical care including factors throughout the early life course, including perinatal, neonatal, and pediatric exposures that impact survivor care later in adulthood. Summary The number of pediatric AKI survivors continues to increase, leading to a higher burden of chronic kidney disease and other long-term co-morbidities later in life. Adult medical providers should consider pediatric history and illnesses to inform the care they provide. Such knowledge may help internists, nephrologists, and intensivists alike to improve risk stratification, including a lower threshold for monitoring for AKI and kidney dysfunction in their patients.

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Acute Kidney Injury in Pediatric Cardiac Intensive Care Children: Not All Admissions Are Equal: A Retrospective Study

Cited by 7 publications

References 32 publications

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Prevalence, risk factors, and outcomes of acute kidney injury in a pediatric cardiac intensive care unit: A cross‐sectional study

Adults are just big kids: pediatric considerations for adult critical care nephrology

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