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Acute kidney injury in children undergoing cardiac surgery: predictive value of kidney arterial Doppler-based variables

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Abstract

Background

Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery.

Methods

In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3.

Results

A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0–37.9) and 7.36 kg (IQR 5.19–11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71–0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69–0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3.

Conclusions

Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.

Graphical Abstract

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Data availability

The data that support the findings of this study are available from the corresponding author, upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

Thank you to Carolina Grotta Ramos Telio for her review of the manuscript. We also thank the legal guardians of the participants, attending physicians, pediatric critical care residents, and the nursing staff.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil

    Fabiane M. De Souza, Aline V. De Carvalho, Isabel S. Ferraz, Ana P. Damiano, Marcelo B. Brandão, Roberto J. N. Nogueira & Tiago H. De Souza

  2. Department of Pediatrics, School of Medicine, São Leopoldo Mandic, Campinas, SP, Brazil

    Roberto J. N. Nogueira

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  1. Fabiane M. De Souza
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Contributions

Conception and design: THdS; acquisition of data: FMdS; AVdC, IdSF, THdS; analysis and interpretation of data: FMdS, IdSF, THdS; drafting the article: FMdS, IdSF, THdS; revising the article critically for important intellectual content: RJNN, MBB, and APD; all of the authors read and approved the manuscript.

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Correspondence to Tiago H. De Souza.

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De Souza, F.M., De Carvalho, A.V., Ferraz, I.S. et al. Acute kidney injury in children undergoing cardiac surgery: predictive value of kidney arterial Doppler-based variables. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06319-3

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