Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 21 , ISSUE 12 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Risk factors and outcome of acute kidney injury after congenital heart surgery: A prospective observational study

Shahram Amini, Hasan Abbaspour, Negar Morovatdar, Hojat Robabi, Ghasem Soltani, Mohammad Tashnizi

Keywords : Acute kidney injury, congenital heart surgery, outcome, prediction

Citation Information : Amini S, Abbaspour H, Morovatdar N, Robabi H, Soltani G, Tashnizi M. Risk factors and outcome of acute kidney injury after congenital heart surgery: A prospective observational study. Indian J Crit Care Med 2017; 21 (12):847-851.

DOI: 10.4103/ijccm.IJCCM_459_16

License: CC BY-ND 3.0

Published Online: 01-07-2013

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Backgrounds and Aims: Acute kidney injury (AKI) is a frequent event after congenital heart surgery with increased mortality and morbidity. We investigated frequency, risk factors, and associated morbidity and mortality of AKI after pediatric cardiac surgery at a single institution. Methods: Children undergoing congenital heart surgery from March 2013 to February 2016 were assessed for development of AKI based on modified pediatric Risk, Injury, Failure, Loss, and End-stage renal disease criteria. They were also investigated for predictive risk factors, associated mortality, and morbidity including duration of mechanical ventilation, Intensive Care Unit (ICU), and hospital length of stay. Results: Five hundred and nineteen patients were recruited during the study period including 259 (49.9%) males and 260 (50.1%) females. AKI was seen in 150 (28.9%) patients including 101 (67.3%), 42 (28%), and 7 (4.7%) cases with risk, injury, and failure stages, respectively. Patients with AKI had longer ventilation time (P = 0.002), ICU (P = 0.05), and hospital (P = 0.56) stay. Mortality was seen in 31 (2.7%) and 44 (11.9%) patients with and without AKI, respectively (P = 0.01). After multivariable logistic regression, there was an association between AKI and preoperative abnormal levels of creatinine (adjusted odds ratio [aOR] = 0.47, 95% confidence interval [CI] 0.22–1.01; P = 0.05), presence of cyanotic heart disease (aOR = 1.97, 95% CI = 1.15–3.2; P = 0.01), duration of surgery (aOR = 1.05/10 min, 95% CI = 1.01–1.08; P = 0.007), and elevated lactate level (aOR = 1.14, 95% CI = 1.03–1.3; P = 0.01). Conclusion: The presence of cyanotic heart disease, duration of surgery, elevated postoperative lactate level, and likely preoperative creatinine level were independent risk factors for the development of AKI after congenital heart surgery.


PDF Share
  1. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012;94:1589-95.
  2. Sugimoto K, Toda Y, Iwasaki T, Shimizu K, Kanazawa T, Muto N, et al. Urinary albumin levels predict development of acute kidney injury after pediatric cardiac surgery: A prospective observational study. J Cardiothorac Vasc Anesth 2016;30:64-8.
  3. Krastins J, Straume Z, Auzins J, Petersons A, Petersons A. Open heart surgery associated acute kidney injury in children. Acta Chir Latviensis 2013;13:37-42.
  4. Sethi SK, Kumar M, Sharma R, Bazaz S, Kher V. Acute kidney injury in children after cardiopulmonary bypass: Risk factors and outcome. Indian Pediatr 2015;52:223-6.
  5. Tóth R, Breuer T, Cserép Z, Lex D, Fazekas L, Sápi E, et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012;93:1984-90.
  6. Lopez-Delgado JC, Esteve F, Torrado H, Rodríguez-Castro D, Carrio ML, Farrero E, et al. Influence of acute kidney injury on short- and long-term outcomes in patients undergoing cardiac surgery: Risk factors and prognostic value of a modified RIFLE classification. Crit Care 2013;17:R293.
  7. Alabbas A, Campbell A, Skippen P, Human D, Matsell D, Mammen C, et al. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: A retrospective study. Pediatr Nephrol 2013;28:1127-34.
  8. dos Santos El Halal MG, Carvalho PR. Acute kidney injury according to pediatric RIFLE criteria is associated with negative outcomes after heart surgery in children. Pediatr Nephrol 2013;28:1307-14.
  9. Cardoso B, Laranjo S, Gomes I, Freitas I, Trigo C, Fragata I, et al. Acute kidney injury after pediatric cardiac surgery: Risk factors and outcomes. Proposal for a predictive model. Rev Port Cardiol 2016;35:99-104.
  10. Sethi SK, Goyal D, Yadav DK, Shukla U, Kajala PL, Gupta VK, et al. Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 2011;15:529-34.
  11. Alkan T, Akçevin A, Türkoglu H, Paker T, Sasmazel A, Bayer V, et al. Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J 2006;52:693-7.
  12. Boigner H, Brannath W, Hermon M, Stoll E, Burda G, Trittenwein G, et al. Predictors of mortality at initiation of peritoneal dialysis in children after cardiac surgery. Ann Thorac Surg 2004;77:61-5.
  13. Conlon PJ, Stafford-Smith M, White WD, Newman MF, King S, Winn MP, et al. Acute renal failure following cardiac surgery. Nephrol Dial Transplant 1999;14:1158-62.
  14. Fleming F, Bohn D, Edwards H, Cox P, Geary D, McCrindle BW, et al. Renal replacement therapy after repair of congenital heart disease in children. A comparison of hemofiltration and peritoneal dialysis. J Thorac Cardiovasc Surg 1995;109:322-31.
  15. Ricci Z, Di Nardo M, Iacoella C, Netto R, Picca S, Cogo P, et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: A single-center prospective observational study. Pediatr Cardiol 2013;34:1404-8.
  16. Watkins SC, Williamson K, Davidson M, Donahue BS. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery. Paediatr Anaesth 2014;24:919-26.
  17. Alkandari O, Eddington KA, Hyder A, Gauvin F, Ducruet T, Gottesman R, et al. Acute kidney injury is an independent risk factor for pediatric Intensive Care Unit mortality, longer length of stay and prolonged mechanical ventilation in critically ill children: A two-center retrospective cohort study. Crit Care 2011;15:R146.
  18. Gil-Ruiz Gil-Esparza MA, Alcaraz Romero AJ, Romero Otero A, Gil Villanueva N, Sanavia Morán E, Rodríguez Sánchez de la Blanca A, et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014;29:1265-72.
  19. Ono M, Arnaoutakis GJ, Fine DM, Brady K, Easley RB, Zheng Y, et al. Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury. Crit Care Med 2013;41:464-71.
  20. Kanji HD, Schulze CJ, Hervas-Malo M, Wang P, Ross DB, Zibdawi M, et al. Difference between pre-operative and cardiopulmonary bypass mean arterial pressure is independently associated with early cardiac surgery-associated acute kidney injury. J Cardiothorac Surg 2010;5:71.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.