Outcomes of adults with congenital heart disease that experience acute kidney injury in the intensive care unit

Fuhrman, Dana Y.; Nguyen, Lan; Joyce, Emily; Priyanka, P.; Kellum, John A.

doi:10.1017/s1047951120003923

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…We identified patient (eg, comorbidities) and CKRT (eg, time to initiation and liberation pattern) characteristics associated with adverse kidney outcomes 90 days after CKRT initiation. It is known that AKI is common in patients with congenital heart disease and is associated with their morbidity and mortality . In this study, we found the highest odds of MAKE-90 outcomes in patients with cardiac comorbidities.…”

Section: Discussionsupporting

confidence: 49%

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Fuhrman,

Stenson,

Alhamoud

et al. 2024

JAMA Netw Open

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ImportanceContinuous kidney replacement therapy (CKRT) is increasingly used in youths with critical illness, but little is known about longer-term outcomes, such as persistent kidney dysfunction, continued need for dialysis, or death.ObjectiveTo characterize the incidence and risk factors, including liberation patterns, associated with major adverse kidney events 90 days after CKRT initiation (MAKE-90) in children, adolescents, and young adults.Design, Setting, and ParticipantsThis international, multicenter cohort study was conducted among patients aged 0 to 25 years from The Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) registry treated with CKRT for acute kidney injury or fluid overload from 2015 to 2021. Exclusion criteria were dialysis dependence, concurrent extracorporeal membrane oxygenation use, or receipt of CKRT for a different indication. Data were analyzed from May 2 to December 14, 2023.ExposurePatient clinical characteristics and CKRT parameters were assessed. CKRT liberation was classified as successful, reinstituted, or not attempted. Successful liberation was defined as the first attempt at CKRT liberation resulting in 72 hours or more without return to dialysis within 28 days of CKRT initiation.Main Outcomes and MeasuresMAKE-90, including death or persistent kidney dysfunction (dialysis dependence or ≥25% decline in estimated glomerular filtration rate from baseline), were assessed.ResultsAmong 969 patients treated with CKRT (529 males [54.6%]; median [IQR] age, 8.8 [1.7-15.0] years), 630 patients (65.0%) developed MAKE-90. On multivariable analysis, cardiac comorbidity (adjusted odds ratio [aOR], 1.60; 95% CI, 1.08-2.37), longer duration of intensive care unit admission before CKRT initiation (aOR for 6 days vs 1 day, 1.07; 95% CI, 1.02-1.13), and liberation pattern were associated with MAKE-90. In this analysis, patients who successfully liberated from CKRT within 28 days had lower odds of MAKE-90 compared with patients in whom liberation was attempted and failed (aOR, 0.32; 95% CI, 0.22-0.48) and patients without a liberation attempt (aOR, 0.02; 95% CI, 0.01-0.04).Conclusions and RelevanceIn this study, MAKE-90 occurred in almost two-thirds of the population and patient-level risk factors associated with MAKE-90 included cardiac comorbidity, time to CKRT initiation, and liberation patterns. These findings highlight the high incidence of adverse outcomes in this population and suggest that future prospective studies are needed to better understand liberation patterns and practices.

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Section: Discussionsupporting

confidence: 49%

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Fuhrman,

Stenson,

Alhamoud

et al. 2024

JAMA Netw Open

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“…Moreover, the authors reported that all patients who died within the first year after hospital discharge had CKD. (Fuhrman et al, 2021) Another study by Kwiatkowski et al reported a 36% incidence of AKI among ACHD patients undergoing cardiac surgery. Significant risk factors for AKI were older age (≥35), underlying left ventricular dysfunction or arrhythmia, longer cardiopulmonary bypass time, and perioperative vancomycin use.…”

Section: Surgery Nephrotoxin Exposure and Kidney Complicationsmentioning

confidence: 99%

Kidney disease and congenital heart disease: Partnership for life

et al. 2022

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The literature on the relationship between kidney and cardiovascular diseases is continuously expanding. Scientists have elucidated many of the neurohormonal and hemodynamic pathways involved in cardiorenal disease. However, little is known about kidney disease in patients with congenital heart disease. Given advances in the medical and surgical care of this highly complex patient population, survival rates have dramatically improved leading to a higher percentage of adults living with congenital heart disease. Accordingly, a noticeable increase in the prevalence of kidney disease is appreciated in these patients. Some of the main risk factors for developing chronic kidney disease in the adult congenital heart disease population include chronic hypoxia, neurohormonal derangements, intraglomerular hemodynamic changes, prior cardiac surgeries from minimally invasive to open heart surgeries with ischemia, and nephrotoxins. Unfortunately, data regarding the prevalence, pathophysiology, and prognosis of chronic kidney disease in the adult congenital heart disease population remain scarce. This has led to a lack of clear recommendations for evaluating and managing kidney disease in these patients. In this review, we discuss contemporary data on kidney disease in adults with congenital heart disease in addition to some of the gaps in knowledge we face. The article highlights the delicate interaction between disease of the heart and kidneys in these patients, and offers the practitioner tools to more effectively manage this vulnerable population.

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“…Recently, KDIGO published an updated definition of AKD in an effort to combine prior definitions and improve future research efforts 7 . Study results have shown that adult patients with cirrhosis, 8 congenital heart disease, 9 and after cardiac procedures 10 meeting criteria for AKD, with or without AKI, have an increased risk of poor outcomes such as progression to CKD and mortality. Currently, there are no studies in pediatric non‐kidney solid organ transplant patients specifically exploring the progression of kidney disease as defined by AKI, AKD, and CKD using the most current definitions.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney disease predicts chronic kidney disease in pediatric non‐kidney solid organ transplant patients

Patel

Heipertz

Joyce

et al. 2021

Pediatric Transplantation

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Background Acute kidney disease (AKD) is defined as impaired kidney function present for <90 days with or without an acute kidney injury (AKI) event. Adults with AKD have an increased risk for progression to chronic kidney disease (CKD) and mortality. There are no data on the epidemiology of AKD in children after transplant. The aim of this study was to evaluate the incidence and risk factors for AKI, AKD, and CKD in children after transplantation. Methods This is a retrospective cohort study of all children undergoing non‐kidney solid organ transplant between 2011 and 2019 at UPMC Children's Hospital of Pittsburgh. AKI and AKD were defined using the Kidney Disease Improving Global Outcomes criteria. Patients with a new estimated glomerular filtration rate <60 ml/min/1.73m2 persisting for >3 months met criteria for new CKD. Variables associated with AKI, AKD, and CKD were analyzed. Results Among 338 patients, 37.9% met criteria for severe AKI, 13% for AKD, and 8% for a new diagnosis of CKD. Stage 3 AKI was independently associated with AKD (OR: 5.35; 95% CI: 2.23–12.86). Severe AKI was not associated with new‐onset CKD, whereas AKD was associated with new‐onset CKD (OR: 29.74; CI: 11.22–78.82). Conclusion AKD may be superior to AKI in predicting risk of CKD in children after non‐kidney solid organ transplantation.

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Outcomes of adults with congenital heart disease that experience acute kidney injury in the intensive care unit

Cited by 8 publications

References 15 publications

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Major Adverse Kidney Events in Pediatric Continuous Kidney Replacement Therapy

Kidney disease and congenital heart disease: Partnership for life

Acute kidney disease predicts chronic kidney disease in pediatric non‐kidney solid organ transplant patients

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