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Preoperative levels of urinary uromodulin predict acute kidney injury after pediatric cardiopulmonary bypass surgery

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Abstract

Background

Acute kidney injury (AKI) is a common complication of cardiopulmonary bypass surgery (CPB) in children. Several promising postoperative AKI biomarkers have been identified, but no preoperative biomarkers are available. We evaluated the association of urinary uromodulin (uUMOD) with postoperative AKI.

Methods

One hundred and one children undergoing CPB were enrolled. Urine was collected prior to CPB, and AKI was defined as ≧50% increase in serum creatinine from preoperative baseline within 48 h of surgery.

Results

Forty-seven patients (47%) developed AKI, and 92% of participants in the lowest quartile of preoperative uUMOD concentrations developed AKI compared with 8% in the highest quartile. Patients with preoperative uUMOD levels in the lowest quartile had 132.3× increased risk of postoperative AKI versus the highest quartile. Raw uUMOD levels were significantly lower in patients with AKI vs. no AKI. Significance was unchanged after correcting uUMOD levels for urinary creatinine. Receiver operating characteristic analysis showed preoperative uUMOD strongly predicted postoperative AKI, with area under the curve (AUC) 0.90. Stepwise logistic regression analysis revealed a model combining uUMOD, and bypass time predicted AKI at p<0.001. Neither Risk Adjustment for Congenital Heart Surgery 1 (RACHS) score nor age improved the model’s ability to predict AKI. Independent analysis demonstrated that while bypass time was associated with AKI, the predictive ability of bypass time (AUC 0.77) was less than that of preoperative uUMOD levels (AUC 0.9).

Conclusions

Children with lowest preoperative levels of uUMOD have greatly increased risk of AKI post-CPB. If uUMOD were used to risk-stratify patients undergoing CPB, clinical measures could be taken to minimize AKI development.

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Acknowledgments

This work was funded by NIH P50 DK096418 to PD.

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Authors and Affiliations

  1. Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, ML 7022, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Michael R. Bennett, Olivia Pyles, Qing Ma & Prasad Devarajan

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  1. Michael R. Bennett
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  2. Olivia Pyles
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  3. Qing Ma
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  4. Prasad Devarajan
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Corresponding author

Correspondence to Michael R. Bennett.

Ethics declarations

This study was approved by the Cincinnati Children’s Hospital Medical Center Internal Review Board and was carried out in accordance with the Declaration of Helsinki. All patients <18 years of age undergoing cardiac surgery with CPB at our center between June 2005 and July 2007 were approached for study inclusion. Written informed consent was obtained from the legal guardian of each patient, and assent was obtained from patients aged ≥11 years at the time of enrollment.

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Bennett, M.R., Pyles, O., Ma, Q. et al. Preoperative levels of urinary uromodulin predict acute kidney injury after pediatric cardiopulmonary bypass surgery. Pediatr Nephrol 33, 521–526 (2018). https://doi.org/10.1007/s00467-017-3823-0

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  • DOI: https://doi.org/10.1007/s00467-017-3823-0

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