Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case–control study

Ruf, Bettina; Bonelli, Vittorio; Balling, Gunter; Hörer, Jürgen; Nagdyman, Nicole; Braun, Siegmund; Ewert, Peter; Reiter, Karl

doi:10.1186/s13054-015-0760-9

Cited by 116 publications

(114 citation statements)

References 40 publications

(64 reference statements)

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“…To our knowledge, this is the first time that a relationship was identified between early measures of renal oximetry by NIRS and the development of AKI in very preterm infants. This result is consistent with that of Ruf et al [14] who demonstrated that prolonged low renal oximetry measured by NIRS during cardiac surgery in newborns was a reliable early parameter for predicting AKI, and even superior to conventional biochemical markers.…”

Section: Discussionsupporting

confidence: 82%

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

et al. 2019

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Background: Acute kidney injury (AKI) is a frequent complication in preterm infants, and the identification of early markers of renal hypoperfusion is a chief challenge in neonatal intensive care units. Objectives: To describe the association between early markers of cardiovascular function and renal perfusion with AKI occurrence in a cohort of preterm infants < 32 weeks’ gestation. Methods: 128 infants were prospectively included from birth to discharge. During the first day of life, we assessed cardiovascular function, systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (rSO₂) using near-infrared spectroscopy (NIRS). These measures were analyzed in relation to developing AKI and serum creatinine (SCr) peak from day 2 to 7 of life. Results: 12 of 128 infants presented with AKI (9.4%). SCr peak was 155.3 ± 30.2 µmol/L in infants with AKI versus 82.0 ± 16.5 in non-AKI infants (p < 0.001). Among all measures of cardiovascular function and renal perfusion, low mean cerebral and renal rSO₂ during the first day of life and a low resistive index at renal artery Doppler were significantly associated with developing AKI. After adjustment for possible confounding factors, low renal rSO₂ on the first day of life remained associated with a high SCr peak from day 2 to 7 of life. Conclusion: Low renal rSO₂ values during the first day of life correlate with developing AKI in preterm infants < 32 weeks’ gestation. NIRS monitoring of renal function during adaptation seems promising, and its very early use after birth to detect kidney hemodynamic dysfunction deserves further investigations.

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Section: Discussionsupporting

confidence: 82%

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

et al. 2019

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“…Notably the rate of AKI is higher than our study population, in which only 3.8% of patients developed severe AKI [20]. Ruf et al, demonstrated a significant correlation between a calculated intraoperative renal NIRS score (which included the baseline value, the current value and the time in minutes, and calculated area under the curve) and the postoperative occurrence of AKI in infants after cardiac surgery.…”

Section: Discussionmentioning

confidence: 54%

“…Renal NIRS has been shown to be predictive of AKI in several small studies, using a series of complex equations or area under the curve (AUC) that do not have clinical relevance for predicting early AKI [19, 20]. One study reported a low renal oximetry of less than 50% for greater than 2 hours to be associated with AKI, and is the most clinically useful renal NIRS parameter assessed to date [21].…”

Section: Introductionmentioning

confidence: 99%

A Decline in Intraoperative Renal Near-Infrared Spectroscopy Is Associated With Adverse Outcomes in Children Following Cardiac Surgery

Gist

Kaufman

Cruz

et al. 2016

Pediatric Critical Care Medicine

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Objective Renal near infrared spectroscopy (NIRS) is known to be predictive of acute kidney injury (AKI) in children following cardiac surgery using a series of complex equations and area under the curve. This study was performed to determine if a ≥ 20% reduction in renal NIRS for 20 consecutive minutes intra-operatively or within the first 24 post-operative hours is associated with 1) AKI, 2) increased AKI biomarkers, or 3) other adverse clinical outcomes in children following cardiac surgery. Design Prospective single center observational study Setting Pediatric cardiac intensive care unit Patients Children less than or equal to age 4 years who underwent cardiac surgery with the use of cardiopulmonary bypass during the study period (June 2011 to July 2012). Interventions None Measurements and Main Results A reduction in NIRS was not associated with AKI. 9/12 (75%) of patients with a reduction in renal NIRS did not develop AKI. The remaining 3 patients had mild AKI (pRIFLE-R). A reduction in renal NIRS was associated with the following adverse clinical outcomes: 1) a longer duration of mechanical ventilation (p = 0.05), 2) longer intensive care length of stay (p = 0.05), and 3) longer hospital length of stay (p < 0.01). A decline in renal NIRS in combination with an increase in serum IL-6 and serum IL-8 was associated with a longer intensive care length of stay, and the addition of urine IL-18 to this was associated with a longer hospital length of stay. Conclusions In this cohort, the rate of AKI was much lower than anticipated thereby limiting the evaluation of a reduction in renal NIRS as a predictor of AKI. A ≥ 20% reduction in renal NIRS was significantly associated with adverse outcomes in children following cardiac surgery. The addition of specific biomarkers to the model was predictive of worse outcomes in these patients. Thus, real time evaluation of renal NIRS using the specific levels of change of a 20% reduction for 20 minutes may be useful in predicting prolonged mechanical ventilation and other adverse outcomes in children undergoing cardiac surgery.

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“…Reduced mean arterial pressure and non-pulsatile renal blood flow during cardiopulmonary bypass (CPB) leads to renal ischemia and hypoxia, with resultant activation of apoptotic and necrotic pathways of tubule and endothelial cell death [25,26]. Direct and convincing evidence for low renal oxygenation during pediatric CPB has been obtained using near-infrared spectroscopy [27–29]. Not surprisingly, the duration of CPB has been the single most consistently identified risk factor for pediatric CS-AKI [1].…”

Section: Incidence and Etiology Of Cardiac Surgery-associated Acutmentioning

confidence: 99%

Early detection of acute kidney injury after pediatric cardiac surgery

Jefferies

Devarajan

2016

Progress in Pediatric Cardiology

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Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy.

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Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass: a case–control study

Cited by 116 publications

References 40 publications

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants

A Decline in Intraoperative Renal Near-Infrared Spectroscopy Is Associated With Adverse Outcomes in Children Following Cardiac Surgery

Early detection of acute kidney injury after pediatric cardiac surgery

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