Acute Kidney Injury Is Associated With Higher Morbidity and Resource Utilization in Pediatric Patients Undergoing Heart Surgery

Tóth, Roland; Breuer, Tamás; Cserép, Zsuzsanna; Lex, Dániel J.; Fazekas, Levente; Sápi, Erzsébet; Szatmári, András; Gál, János; Székely, Andrea

doi:10.1016/j.athoracsur.2011.10.046

Cited by 102 publications

(68 citation statements)

References 25 publications

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“…[1,4,13,14] Several studies have attempted to identify the risk factors of ARF requiring RRT in pediatric patients undergoing congenital cardiac surgery. [2,7,14] In consistent with previous studies, [15][16][17] patients who showed recovery of renal function following PD with associated lower CPB and CC times, RACHS-1 category and inotrope scores, BUN and SCr values before PD and a lower time interval between surgery and PD had lower mortality. Additionally, in the present study, higher MAP and CVP scores before PD, late beginning of PD, lower perioperative urine output, and lower diuresis after PD were significant risk factors for increased mortality.…”

Section: Discussionsupporting

confidence: 77%

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Ayık¹

2017

Turk Gogus Kalp Dama

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Section: Discussionsupporting

confidence: 77%

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Ayık¹

2017

Turk Gogus Kalp Dama

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“…Moreover, this discrepancy between higher CS-AKI rates and shorter mechanical ventilation and LOS at UM suggests that not all CS-AKI is created equal. Multiple studies have described discrepant CS-AKI incidence and outcome associations (1–4, 7). Our data lend credence to the hypothesis that MUF-related early increases in serum creatinine may represent volume shifts rather than glomerular or interstitial injury.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury After Pediatric Cardiac Surgery: A Secondary Analysis of the Safe Pediatric Euglycemia After Cardiac Surgery Trial*

Blinder

Asaro

Wypij

et al. 2017

Pediatric Critical Care Medicine

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Objectives To understand the effect of tight glycemic control (TGC) on cardiac surgery-associated acute kidney injury (CS-AKI). Design Secondary analysis of data from the Safe Pediatric Euglycemia after Cardiac Surgery (SPECS) trial of TGC vs. standard care Setting Pediatric cardiac intensive care units (ICU) at University of Michigan (UM) C.S. Mott Children’s Hospital and Boston Children’s Hospital (BCH). Patients Children 0–36 months of age undergoing congenital cardiac surgery. Interventions None. Measurements and Main Results CS-AKI was assigned using the Acute Kidney Injury Network criteria with the modification that a >0.1 mg/dL increase in serum creatinine was required to assign CS-AKI. We explored associations between CS-AKI and TGC and clinical outcomes. Of 799 patients studied, CS-AKI occurred in 289 (36%) patients, most of whom had Stage II or III disease (72%). CS-AKI rates were similar between treatment groups (36% vs. 36%, p=0.99). Multivariable modeling showed that patients with CS-AKI were younger (p=0.002), underwent more complex surgery (p=0.005) and had longer cardiopulmonary bypass times (p=0.002). CS-AKI was associated with longer mechanical ventilation and ICU and hospital stays and increased mortality. Patients at UM had higher rates of CS-AKI compared to BCH patients (66% vs. 15%, p<0.001) but UM patients with CS-AKI had shorter time to extubation and ICU and hospital stays compared to BCH. Conclusions TGC did not reduce the CS-AKI rate in this trial cohort. We observed significant differences in CS-AKI rates between the two study sites, and there was a differential effect of CS-AKI on clinical outcomes by site. These findings warrant further investigation to identify causal variation in perioperative practices that affect CS-AKI epidemiology.

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“…1-3 Several studies have evaluated the numerous risk factors associated with the development of AKI following surgery for congenital heart conditions. [1][2][3][4][5][6][7] There are various diagnostic criteria for pediatric AKI that are based on serum creatinine (SCr) and urine output (UO), but the validity of AKI diagnosis remains unclear. 2,8, 9 The RIFLE criteria are the most commonly used for the diagnosis of AKI.…”

Section: Subjects and Study Designmentioning

confidence: 99%

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

Lee

Kim

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 Is Associated With Higher Morbidity and Resource Utilization in Pediatric Patients Undergoing Heart Surgery

Cited by 102 publications

References 25 publications

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Acute Kidney Injury After Pediatric Cardiac Surgery: A Secondary Analysis of the Safe Pediatric Euglycemia After Cardiac Surgery Trial*

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

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Acute Kidney Injury Is Associated With Higher Morbidity and Resource Utilization in Pediatric Patients Undergoing Heart Surgery

Cited by 102 publications

References 25 publications

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Peritoneal dialysis in children undergoing congenital cardiac surgery under three years of age

Acute Kidney Injury After Pediatric Cardiac Surgery: A Secondary Analysis of the Safe Pediatric Euglycemia After Cardiac Surgery Trial*

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

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