Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Zanaboni, Dominic; Min, Jungwon; Seshadri, Roopa; Gaynor, J. William; Dreher, Molly; Blinder, Joshua J.

doi:10.1007/s00467-021-04976-2

Cited by 6 publications

(3 citation statements)

References 33 publications

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“…Data from our study also supports previously published literature that showed higher indexed ultrafiltration volume was associated with increased CS-AKI risk [33]. While this outcome is not directly related to DO 2 i, it does present an additional potentially modifiable CS-AKI risk factor.…”

Section: Discussionsupporting

confidence: 91%

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Dreher¹,

Min²,

Mavroudis³

et al. 2023

J Extra Corpor Technol

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Background: Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort. Methods: This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013 and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 – 400 mL/min/m2 were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk. Results: We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m2 predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60– 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m2 predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 – 0.72, sensitivity = 52.6%, specificity = 74.6%). Conclusion: Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m2 in complex neonates and greater than 400 mL/min/m2 in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.

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Section: Discussionsupporting

confidence: 91%

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Dreher¹,

Min²,

Mavroudis³

et al. 2023

J Extra Corpor Technol

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“…One potential explanation for the presence of CKD in this population is persistent damage after AKI resulting from aortic clamping or hemodynamic imbalances during cardiopulmonary bypass. 28 However, we did not observe any differences in cardiopulmonary bypass or cross clamp time in those who developed CKD and those who did not. Although not measured in this study, cardiopulmonary bypass can lead to fluid shifts, increased blood vessel permeability, and depressed myocardial contractility, resulting in fluid overload.…”

Section: Discussioncontrasting

confidence: 57%

Persistent Markers of Kidney Injury in Children Who Developed Acute Kidney Injury After Pediatric Cardiac Surgery: A Prospective Cohort Study

Eynde

Salaets

Louw

et al. 2022

JAHA

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Background Acute kidney injury (AKI) after pediatric cardiac surgery is common. Longer‐term outcomes and the incidence of chronic kidney disease after AKI are not well‐known. Methods and Results All eligible children (aged <16 years) who had developed AKI following cardiac surgery at our tertiary referral hospital were prospectively invited for a formal kidney assessment ≈5 years after AKI, including measurements of estimated glomerular filtration rate, proteinuria, α 1 ‐microglobulin, blood pressure, and kidney ultrasound. Longer‐term follow‐up data on kidney function were collected at the latest available visit. Among 571 patients who underwent surgery, AKI occurred in 113 (19.7%) over a 4‐year period. Fifteen of these (13.3%) died at a median of 31 days (interquartile range [IQR], 9–57) after surgery. A total of 66 patients participated in the kidney assessment at a median of 4.8 years (IQR, 3.9–5.7) after the index AKI episode. Thirty‐nine patients (59.1%) had at least 1 marker of kidney injury, including estimated glomerular filtration rate <90 mL/min per 1.73 m 2 in 9 (13.6%), proteinuria in 27 (40.9%), α 1 ‐microglobinuria in 5 (7.6%), hypertension in 13 (19.7%), and abnormalities on kidney ultrasound in 9 (13.6%). Stages 1 to 5 chronic kidney disease were present in 18 (27.3%) patients. Patients with CKD were more likely to have an associated syndrome (55.6% versus 20.8%, P =0.015). At 13.1 years (IQR, 11.2–14.0) follow‐up, estimated glomerular filtration rate <90 mL/min per 1.73 m² was present in 18 of 49 patients (36.7%), suggesting an average estimated glomerular filtration rate decline rate of −1.81 mL/min per 1.73 m² per year. Conclusions Children who developed AKI after pediatric cardiac surgery showed persistent markers of kidney injury. As chronic kidney disease is a risk factor for cardiovascular comorbidity, long‐term kidney follow‐up in this population is warranted.

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“…However, if the child's weight was 14 kg just 2 months ago at a well child visit and this was due to acute gastroenteritis, the definition of fluid overload at this point might not hold based on our common measurement methods (weight-based or metric-based) and the patients might reasonably be considered as a positive FB. There is not yet a standard approach to defining FB or fluid overload and from the nine pediatric-focused original research articles published from 2020 through March 2022 there were more than 12 different definitions with multiple additional combinations possible [ 2 ▪ , 3 , 4 ▪ , 5 ▪▪ , 6 , 7 ▪▪ , 8 , 9 ▪ , 10 ▪ ] (Table 1 ). The different definitions included metric vs. weight-based methods, considered different baseline (or anchor) weight, and different percentage thresholds (e.g., 10% vs. 20% vs. continuous).…”

Section: Fluid Balance and Fluid Overload: Definition And Measurementmentioning

confidence: 99%

Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)

Ricci

Bjornstad

2022

Current Opinion in Critical Care

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Purpose of reviewThe issues of fluid balance and fluid overload are currently considered crucial aspects of pediatric critically ill patients’ care.Recent findingsThis review describes current understanding of fluid management in critically ill children in terms of fluid balance and fluid overload and its effects on patients’ outcomes. The review describes current evidence surrounding definitions, monitoring, and treatment of positive fluid balance. In particular, the review focuses on specific patient conditions, including perioperative cardiac surgery, severe acute respiratory failure, and extracorporeal membrane oxygenation therapy, as the ones at highest risk of developing fluid overload and poor clinical outcomes. Gaps in understanding include specific thresholds at which fluid overload occurs in all critically ill children or specific populations and optimal timing of decongestion of positive fluid balance.SummaryCurrent evidence on fluid balance in critically ill children is mainly based on retrospective and observational studies, and intense research should be recommended in this important field. In theory, active decongestion of patients with fluid overload could improve mortality and other clinical outcomes, but randomized trials or advanced pragmatic studies are needed to better understand the optimal timing, patient characteristics, and tools to achieve this.

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Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Cited by 6 publications

References 33 publications

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury

Persistent Markers of Kidney Injury in Children Who Developed Acute Kidney Injury After Pediatric Cardiac Surgery: A Prospective Cohort Study

Fluid balance in pediatric critically ill patients (with and without kidney dysfunction)

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