Congenital heart surgery in infants: Effects of acute kidney injury on outcomes
ABSTRACT We sought to characterize factors and outcomes associated with postoperative acute kidney injury in infants undergoing cardiac surgery.
We retrospectively studied 430 infants (<90 days) who underwent heart surgery for congenital defects. With a pediatric modified version of the Acute Kidney Injury Network classification, we performed statistical analyses to detect factors and outcomes associated with postoperative acute kidney injury.
Postoperative acute kidney injury occurred in 225 patients (52%): 135 patients (31%) reached maximum acute kidney injury stage I, 59 (14%) reached stage II, and 31 (7%) reached stage III. On multivariable analysis, single-ventricle status (odds ratio, 1.6; 95% confidence interval, 1.08-2.37; P = .02), cardiopulmonary bypass (odds ratio, 1.2; 95% confidence interval 1.01-1.47; P = .04), and higher reference serum creatinine (odds ratio, 5.1; 95% confidence interval, 1.94-13.2; P = .0009) were associated with postoperative acute kidney injury. Thirty-two (7%) patients died in the hospital. Multivariable logistic regression showed that more severe acute kidney injury was associated with in-hospital mortality (maximum acute kidney injury stage II odds ratio, 5.1; 95% confidence interval, 1.7-15.2; P = .004; maximum acute kidney injury stage III odds ratio, 9.46; 95% confidence interval, 2.91-30.7; P = .0002) and longer mechanical ventilation and inotropic support. All acute kidney injury stages were associated with longer intensive care durations. Stage III acute kidney injury was associated with systemic ventricular dysfunction at hospital discharge.
Perioperative acute kidney injury is common in infant heart surgery and portends a poor clinical outcome.
SourceAvailable from: Sidharth Kumar Sethi[Show abstract] [Hide abstract]
ABSTRACT: Objective: To determine the incidence, risk factors and outcomes of acute kidney injury in children undergoing cardiac surgery for congenital heart disease. Methods: We enrolled 208 patients undergoing cardiac surgery for congenital heart disease during January 2012 to March 2013. Acute kidney injury was defined as per Acute Kidney Injury Network criteria. Results: Twenty patients had Acute kidney injury; 14 were infants. Age <1 yr, cardiopulmonary bypass time, prolonged ventilator requirement, pump failure, sepsis and hematological complications were identified as independent risk factors for any degree for acute kidney injury. All patients with acute kidney injury recovered the kidney function at the time of discharge. Conclusions: Acute kidney injury is common in children after cardiac surgery, especially in infants.Indian pediatrics 03/2015; 52(3):223. · 1.01 Impact Factor
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ABSTRACT: Although several standardized definitions for AKI have been developed, no consensus exists regarding which to use in children. This study applied the Pediatric RIFLE (pRIFLE), AKI Network (AKIN), and Kidney Disease Improving Global Outcomes (KDIGO) criteria to an anonymized cohort of hospitalizations extracted from the electronic medical record to compare AKI incidence and outcomes in intensive care unit (ICU) and non-ICU pediatric populations. Observational, electronic medical record-enabled study of 14,795 hospitalizations at the Lucile Packard Children's Hospital between 2006 and 2010. AKI and AKI severity stage were defined by the pRIFLE, AKIN, and KDIGO definitions according to creatinine change criteria; urine output criteria were not used. The incidences of AKI and each AKI stage were calculated for each classification system. All-cause, in-hospital mortality and total hospital length of stay (LOS) were compared at each subsequent AKI stage by Fisher exact and Kolmogorov-Smirnov tests, respectively. AKI incidences across the cohort according to pRIFLE, AKIN, and KDIGO were 51.1%, 37.3%, and 40.3%. Mortality was higher among patients with AKI across all definitions (pRIFLE, 2.3%; AKIN, 2.7%; KDIGO, 2.5%; P<0.001 versus no AKI [0.8%-1.0%]). Within the ICU, pRIFLE, AKIN, and KDIGO demonstrated progressively higher mortality at each AKI severity stage; AKI was not associated with mortality outside the ICU by any definition. Both in and outside the ICU, AKI was associated with significantly higher LOS at each AKI severity stage across all three definitions (P<0.001). Definitions resulted in differences in diagnosis and staging of AKI; staging agreement ranged from 76.7% to 92.5%. Application of the three definitions led to differences in AKI incidence and staging. AKI was associated with greater mortality and LOS in the ICU and greater LOS outside the ICU. All three definitions demonstrated excellent interstage discrimination. While each definition offers advantages, these results underscore the need to adopt a single, universal AKI definition. Copyright © 2015 by the American Society of Nephrology.Clinical Journal of the American Society of Nephrology 02/2015; DOI:10.2215/CJN.01900214 · 5.25 Impact Factor
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ABSTRACT: Acute kidney injury (AKI) is independently associated with poor outcomes in the critically ill patient. The standard kidney function biomarker, serum creatinine, shows a demonstrable rise in concentration many hours to days after insult to the kidney. Thus, creatinine-based AKI diagnosis is likely delayed, rendering treatments to mitigate or prevent AKI ineffective. Neonatal AKI is further confounded by the fact that infant serum creatinine concentrations reflect maternal levels. The past 15 years has seen a massive research effort to identify early damage markers of AKI, with the hope that earlier “sub-clinical” AKI diagnosis can lead to earlier initiation of AKI treatment, or to adjustment of care to mitigate the adverse effects of AKI until renal function recovery occurs. One of the most promising urinary AKI biomarkers, neutrophil gelatinase associated lipocalin (NGAL), has repeatedly performed well to predict AKI in many pediatric populations, including those post-cardiac surgery, critically ill mechanically ventilated children and children arriving to the emergency department. The study reported by Admani et al. uses NGAL not only to predict serum creatinine-based AKI, but also to define AKI to associate a Day 1 NGAL concentration above a specific threshold with clinical outcomes.Pediatric Nephrology 02/2015; DOI:10.1007/s00467-015-3046-1 · 2.88 Impact Factor