Acute Kidney Injury Predictors and Outcomes after Cardiac Surgery in Children with Congenital Heart Disease: An Observational Cohort Study

Abstract

Acute Kidney Injury (AKI) commonly complicates cardiac surgery in children with congenital heart disease (CHD). In this study we assessed incidence, risk factors, and outcomes of postoperative AKI, while testing the hypothesis that, depending on the underlying diagnosis, there would be significant differences in AKI incidence among different diagnostic groups. We conducted an observational cohort study of children with CHD undergoing cardiac surgery in a single tertiary center between January 2019 and August 2021 (n = 362). Kidney Disease Improving Global Outcome (KDIGO) criteria were used to determine the incidence of postoperative AKI. Diagnosis was incorporated into multivariate models using an anatomic-based CHD classification system. Overall survival was estimated using Kaplan–Meier curves. Log-rank test and adjusted Cox proportional hazard modelling were used to test for differences in survival distributions and determine AKI effect on survival function, respectively. AKI occurred in 70 (19.3%), with 21.4% in-hospital mortality for AKI group. Younger age, lower weight, longer cardiopulmonary bypass time, preoperative mechanical ventilation and diagnostic category were associated with postoperative AKI. Resolution rate was 92.7% prior to hospital discharge for survivors. AKI was associated with longer duration of mechanical ventilation, ICU and hospital length of stay. AKI patients had significantly higher probability of all-cause mortality postoperatively when compared to the non-AKI group (log-rank test, p < 0.001). Adjusted hazard ratio for AKI versus non-AKI group was 11.08 (95% CI 2.45–50.01; p = 0.002). Diagnostic category was associated with cardiac surgery-related AKI in children with CHD, a finding supporting the development of lesion specific models for risk stratification. Postoperative AKI had detrimental impact on clinical outcomes and was associated with decreased survival to hospital discharge.

Incidence and risk factors for acute kidney injury in children with congenital heart disease undergoing cardiac surgery in a tertiary care center.

“…The proportion of AKI found in this study is lower than what was reported by Kourelis et al from Greece. 14 Some researchers have shown that AKI incidence following cardiac repair can vary widely, spanning from 11.5% to 62%. [15][16][17][18] The documented in-hospital mortality related to AKI ranges from 1.1% to 79%.…”

Discovery and functional investigation of BMP4 as a new causative gene for human congenital heart disease

“…As an array of cardiovascular developmental deformations, CHD is clinically categorized into > 30 distinct isoforms, encompassing double-outlet right ventricle (DORV) and ventricular septal defect (VSD) [2,[7][8][9][10][11][12][13][14]. Though certain mild/minor forms of CHD may resolve spontaneously [2], severe/complex forms of CHD usually lead to worse quality of life [15][16][17], reduced exercise performance [18][19][20][21], neurodevelopmental delay and structural brain anomaly [22][23][24][25][26], ischemic/thromboembolic stroke [27,28], acute renal injury/chronic kidney disease [29][30][31][32], hepatic fibrosis [33,34], pulmonary dysplasia/ pulmonary arterial hypertension [35][36][37], bacte-Am J Transl Res 2024;16 (5):2034-2048 rial endocarditis [38][39][40][41][42], chronic heart failure [43][44][45], supraventricular/ventricular arrhythmias [46][47]…”

Somatic GATA4 mutation contributes to tetralogy of Fallot

“…As a global pediatric concern, congenital heart defects comprise a wide spectrum of cardiovascular developmental defects, which are categorized into >25 distinct clinical subtypes, including tetralogy of Fallot (TOF) (1). Although certain minor congenital heart defects spontaneously resolve, severe congenital heart disease may lead to poor health and quality of life (5)(6)(7)(8), diminished physical exercise capacity (9)(10)(11)(12)(13), impaired neurodevelopment (the most prevalent extracardiac manifestation in patients with a congenital heart defect) and brain damage (14)(15)(16)(17)(18), thromboembolic complications (19)(20)(21), acute renal injury and chronic kidney disease (22)(23)(24), hepatic dysfunction (25), pulmonary arterial hypertension (26)(27)(28), infective endocarditis (29)(30)(31), congestive cardiac failure (32)(33)(34), miscellaneous cardiac dysrhythmia (35)(36)(37) and cardiovascular demise (38)(39)(40). Improvement has been made in cardiovascular surgery and transcatheter interventional treatment, which has allowed >90% of children with congenital heart defects to survive to adulthood; adults living with various congenital heart defects outnumber children affected by congenital heart defects (41)…”