Independent Risk Factors and 2-Year Outcomes of Acute Kidney Injury after Surgery for Congenital Heart Disease

Hirano, Daishi; Itō, Akira; Yamada, Akifumi; Kakegawa, Daisuke; Miwa, Saori; Umeda, Chisato; Chiba, Kosuke; Takemasa, Yoichi; Tokunaga, Ai; Ida, Hiroyuki

doi:10.1159/000480358

Cited by 60 publications

(42 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 1.8% rate of requiring RRT is consistent with the 1–5% that was previously reported [ 22 ]. Potential preoperative and intraoperative factors contributing to the difference in AKI frequency [ 23 ], such as younger age, small body size, higher RACHS-1 score and CPB strategy were matched 1:1 by the propensity score between patients who had AKI and those who did not. We found that patients with AKI still had higher intraGF after propensity matching the above variables.…”

Section: Discussionmentioning

confidence: 99%

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Duan

Jiang

et al. 2018

Renal Failure

View full text Add to dashboard Cite

Objective: The association between poor intraoperative glycemic control and postoperative acute kidney injury (AKI) in adult cardiac surgery has been observed, but data in the pediatrics remain unknown. We performed a hypothesis that intraoperative hyperglycemia and/or wider glycemic fluctuation were associated with the incidence of postoperative AKI in pediatric cardiac surgery.Methods: A retrospective study was performed in pediatrics who underwent cardiac surgery from 2013 to 2016. Perioperative glycemic data up to 48 hours after surgery were collected and analyzed. Patients with AKI were matched 1:1 with patients without AKI by a propensity score. Variables of demographic data, preoperative renal function and glycemic level, perioperative cardiac condition were matched.Results: The incidence of AKI was 11.5% (118/1026), with 53.4% (63/118), 30.5% (36/118), and 16.1% (19/118) categorized as AKIN stages I, II, and III, respectively. Children who experienced AKI were younger and cyanotic, underwent more complex surgeries, had higher peak intraoperative glucose levels, wider intraoperative glycemic fluctuation, greater inotropic scores and more transfusions, and poor outcomes (all p < .05). After matching, the AKI group had significantly wider intraoperative glycemic fluctuation (p < .05). Logistic regression showed intraoperative glycemic fluctuation was one of the risk factors for AKI (p = .033) and degree of AKI severity stage increased when the glycemic fluctuation increased (p < .01).Conclusions: Wider intraoperative glycemic fluctuation, but not hyperglycemia, was associated with an increased incidence of postoperative AKI after pediatric cardiac surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Duan

Jiang

et al. 2018

Renal Failure

View full text Add to dashboard Cite

show abstract

“…Interestingly, an association between duration of CPB or cross clamp and AKI was found only after surgery 2. Many earlier studies reported that longer CPB duration was a major risk factor for AKI, conferring up to 7 times greater odds if CPB duration was greater than 180 minutes (4,11). Contrarily, a lack of association between CPB duration and AKI has been found by several other groups (15,25,26).…”

Section: Discussionmentioning

confidence: 97%

“…Several well described risk factors for AKI include younger age at surgery, single ventricle physiology, surgical complexity, and cardiopulmonary bypass (CPB) duration (1,2,4,6). CPB-associated AKI, irrespective of the cause, is associated with increased morbidity, including post-operative infection (7,8), increased duration of mechanical ventilation, hospital length of stay, and increased mortality (1,3,4,6,(9)(10)(11)(12)(13). These all lead to increased hospital costs (14).…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Hasson

Brinton

Cowherd

et al. 2019

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

Objective: Determine the risk factors for repeated episodes of acute kidney injury (AKI) in children who undergo multiple cardiac surgical procedures Design: Single center retrospective chart review Setting: Cardiac intensive care unit at a quaternary pediatric care center Patients: Birth to 18 years who underwent at least 2 cardiac surgical procedures with cardiopulmonary bypass. Interventions: None Measurements and Main Results: 180 patients underwent 2 cardiac surgical procedures and 89 underwent 3. AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. AKI incidence was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most AKI occurring on post-operative days 1 and 2. The proportion of patients with severe AKI increased from surgery 1 to surgery 3. Patients with AKI had a significantly longer duration of ventilation and length of stay after each surgery. The odds of AKI after surgery 3 was 2.40 times greater if AKI was present after surgery 1 or 2 (95% CI: 1.26 to 4.56, p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with AKI (p = 0.85). Conclusions: In a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of AKI after a third surgery was

show abstract

“…Hu and colleagues using either the RIFLE (Risk, Injury, Failure, Loss, End-Stage Renal Disease, based on serum creatinine, urine output and/or glomerular ltration rate, GFR), AKIN (Acute Kidney Injury Network, based on serum creatinine and not on GFR changes), or KDIGO (Kidney Disease: Improving Global Outcomes) criteria (combining the differences between the RIFLE and AKIN) have estimated a global incidence of AKI after cardiac surgery at 22.3% [1]. Based on the pRIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) criteria, AKI developed postoperatively in 24.9% of the patients [3], and de ning AKI by the KDIGO criteria revealed that 42% of the patients included in the respective study met the diagnostic criteria for AKI [4].…”

Section: Introductionmentioning

confidence: 99%

Risk assessment of acute kidney injury following cardiopulmonary bypass

Wittlinger

Maus

Kutschka³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Acute kidney injury (AKI) is a frequent and serious complication of cardiac surgery, associated with a high incidence of morbidity and mortality. Although the RIFLE criteria serve as a prominent tool to identify patients at high risk of AKI, an optimized diagnosis model in clinical practice is desired.Methods: Based on the SOP-criteria, 365 patients (10%) developed AKI following surgery and were subjected to RRT. In contrast, the incidence of AKI, defined according to the RIFLE criteria, was only 7% (n=251 patients). Prominent risk factors identified by SOP were patients’ sex, valve and combined valve and bypass surgery, deep hypothermia, use of intra-aortic balloon pump (IABP) and previous coronary interventions. Ischemia, reperfusion, blood loss and surgery time also served as significant risk factors for patient evaluated by SOP.Results: Risk assessment by RIFLE differed in as much as most patients with normothermia and those receiving only cardiovascular bypass developed AKI. However, patients’ sex and valve surgery did not serve as a risk factor.Conclusion: Evaluation of patients by the RIFLE versus SOP criteria yielded different results with more AKI patients detected by SOP. Based on the present data, it is concluded that patients may not prone to AKI when surgery and ischemia time will be kept short, when blood loss is mitigated to a minimum and when surgery is performed under non-hypothermic conditions

show abstract

Independent Risk Factors and 2-Year Outcomes of Acute Kidney Injury after Surgery for Congenital Heart Disease

Cited by 60 publications

References 25 publications

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Wider intraoperative glycemic fluctuation increases risk of acute kidney injury after pediatric cardiac surgery

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Risk assessment of acute kidney injury following cardiopulmonary bypass

Contact Info

Product

Resources

About