Kidney Disease: Improving Global Outcomes in neonates with acute kidney injury after cardiac surgery

Ueno, Koichi; Shiokawa, Naohiro; Takahashi, Yoshihiro; Nakae, Koji; Kawamura, Jumpei; Imoto, Yutaka; Kawano, Yoshifumi

doi:10.1007/s10157-019-01805-7

Cited by 26 publications

(15 citation statements)

References 26 publications

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“…Patients with PPD placement also had statistically higher incidences of KDIGO Stage 1 and Stage 2 acute kidney injury in univariate analysis, with a rate of 24% that is consistent with prior literature [ 13 , 14 ]. Multivariable adjustment demonstrated no significant difference between the two groups for the incidence of KDIGO Stage 1 AKI, but the difference still trends toward significance for the incidence of KDIGO Stage 2.…”

Section: Discussionsupporting

confidence: 88%

Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery

et al. 2020

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Infants undergoing congenital heart surgery (CHS) with cardiopulmonary bypass (CPB) are at risk of acute kidney injury (AKI) and fluid overload. We hypothesized that placement of a passive peritoneal drain (PPD) can improve postoperative fluid output in such infants. We analyzed 115 consecutive patients, age birth to 60 days, admitted to the PICU after CHS with CPB between 2012 and 2018. Patients who needed postoperative ECMO were excluded. Linear and logistic regression models compared postoperative fluid balances, diuretics administration, AKI, vasoactive-inotropic scores (VIS), time intubated, and length of stay after adjusting for pre/operative predictors including STAT category, bypass time, age, weight, and open chest status. PPD patients had higher STAT category ( p = 0.001), longer CPB times ( p = 0.001), and higher VIS on POD 1–3 ( p ≤ 0.005 daily). PPD patients also had higher AKI rates ( p = 0.01) that did not reach significance in multivariable modeling. There were no postoperative deaths. Postoperative hours of intubation, hospital length of stay, and POD 1–5 fluid intake did not differ between groups. Over POD 1–5, PPD use accounted for 48.8 mL/kg increased fluid output (95% CI [2.2, 95.4], p = 0.043) and 3.41 mg/kg less furosemide administered (95% CI [1.69, 5.14], p < 0.001). No PPD complications were observed. Although PPD placement did not affect end-outcomes, it was used in higher acuity patients. PPD placement is associated with improved fluid output despite lower diuretic administration and may be a useful postoperative fluid management adjunct in some complex CHS patients.

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Section: Discussionsupporting

confidence: 88%

Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery

et al. 2020

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“…Postoperative acute kidney injury (AKI), a common complication of cardiac surgery [ 7 ], is a clinical syndrome characterized by water, electrolyte, and acid-base imbalances, and accumulation of nitrogenous wastes caused by a rapid decrease in glomerular filtration function within hours to weeks [ 8 ]. AKI occurs in 2.7–70% of patients with CHD who undergo cardiac surgery [ 9 , 10 ]. The inconsistent incidence rates of AKI in patients with CHD may be associated with the differences in patient population, sample size, and AKI identification and classification criteria among studies.…”

Section: Introductionmentioning

confidence: 99%

A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease

Li¹,

Niu²,

Huang³

et al. 2020

BMC Nephrol

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Background Acute kidney injury (AKI) is a common complication of cardiac surgery. However, the incidence rate of AKI in patients with congenital heart disease (CHD) greatly varies between reports owing to the different definitions used for AKI. Therefore, this study was designed as a meta-analysis aimed at summarizing the incidence rate of AKI in patients with congenital heart disease (CHD) on the basis of different AKI criteria. Methods Studies published till April 24, 2020, on the incidence rate of AKI in patients with CHD, were retrieved from electronic databases and printed literature. To pool data from the included studies, the effect size, a combined statistics, was chosen and presented with the incidence rate and 95% confidence interval (CI). Heterogeneity was evaluated using I 2 statistics and Cochran Q test. The incidence rates obtained from the subgroup analysis according to study location, type of surgery, type of cohort, age, and AKI criteria) were also evaluated to determine the correlation of AKI with these factors. Publication bias was estimated using the Egger test. Results Thirty studies, comprising 9925 patients with AKI who had CHD, were included. Overall, the pooled incidence rate of AKI in the patients with CHD was 38.4% (95% CI, 32.0–44.7%). However, the incidence rate was not significantly affected by gender, study location, type of surgery, type of cohort, and AKI criteria. Moreover, age was significantly associated with the incidence of AKI, and the incidence rate was higher in the patients aged < 1 month than in those aged 1 month to 18 years, < 18 years, and ≥ 18 years ( P < 0.05). Conclusions In this study, the estimated incidence rate of AKI in patients with CHD was 38.4% and may be influenced by age. These findings highlight the importance of further investigation of the specific causes of and effective preventive measures for AKI.

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“…25 The basis of their work was previous evidence showing an independent association of hyperchloremia with AKI in critically ill adults. 26 Using univariate analysis, the authors found no relationship of preoperative serum chloride with development of AKI, though postoperative hyperchloremia (using time-weighted averages) was associated with development of AKI. The authors' secondary outcomes of ICU LOS and mortality showed no association with chloride levels.…”

Section: Acute Kidney Injury In Congenital Cardiac Surgerymentioning

confidence: 97%

“…Ueno et al published 2 studies investigating the validation of the KDIGO criteria for AKI in neonates and infants, respectively. 26,27 Their retrospective study of 81 neonates undergoing cardiac surgery defined AKI using the neonatal-modified KDIGO (n-KDIGO) criteria. They found the incidence of AKI by the aforementioned criteria was 70.4%.…”

Section: Acute Kidney Injury In Congenital Cardiac Surgerymentioning

confidence: 99%

“…Multivariate analysis also revealed that n-KDIGO stage 3 to be an independent risk factor for 30-day mortality (OR ¼ 16.0; 95% CI ¼1.6-162.1; P ¼ .019). 26 The authors then conducted a similar retrospective study on 145 infants undergoing cardiac surgery with the goal of comparing and validating the incidence and outcomes of AKI as defined by the modified KIDIGO (m-KDIGO), pediatric Risk, Injury, Failure, Loss, End-Stage Disease (p-RIFLE), and Acute Kidney Injury Network (AKIN) criteria. Modified-KDIGO criteria appeared to provide more important postoperative outcomes information, and described clinically relevant AKI in infants after cardiac surgery.…”

Section: Acute Kidney Injury In Congenital Cardiac Surgerymentioning

confidence: 99%

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The Year in Review: Anesthesia for Congenital Heart Disease 2019

Houska

Schwartz

2020

Semin Cardiothorac Vasc Anesth

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Kidney Disease: Improving Global Outcomes in neonates with acute kidney injury after cardiac surgery

Cited by 26 publications

References 26 publications

Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery

Prophylactic Peritoneal Drainage is Associated with Improved Fluid Output after Congenital Heart Surgery

A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease

The Year in Review: Anesthesia for Congenital Heart Disease 2019

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