Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study
- 865 Downloads
Cardiac surgery is a known risk factor for acute kidney injury (AKI) in children. However, cardiac surgery-associated AKI (CS-AKI) in neonates has not been well studied. The objectives of this study were: (1) to describe the epidemiology of CS-AKI in neonates utilizing the Acute Kidney Injury Network (AKIN) definition, (2) to identify risk factors for neonatal CS-AKI, and (3) to determine if neonatal CS-AKI is associated with increased morbidity and mortality.
This was a retrospective study involving 122 neonates (≤28 days) undergoing cardiac surgery from 2006 to 2009. Neonates with and without AKI were identified using serum creatinine (SCr) and urine output (UO) data.
Cardiac surgery-AKI occurred in 76 (62 %) neonates, of whom 22 (29 %) were AKIN stage 1, 19 (25 %) were stage 2, and 35 (46 %) were stage 3. AKI mostly occurred early as 75 % of patients achieved their maximal AKIN stage within the first 48 h post-operatively. In the multivariate analysis, cardiopulmonary bypass duration of ≥120 min was independently associated with AKI [odds ratio (OR) 2.53, 95 % confidence interval (CI) 1.03–6.30]. Severe AKI (AKIN stage 3) was independently associated with mortality (OR 6.70, 95 % CI 1.08–41.50) and a longer stay in the pediatric intensive care unit (hazard ratio 9.09, 95 % CI 1.35–60.95). The majority of severe AKI cases (65 %) were identified with AKIN UO criteria alone without significant rises in SCr.
Cardiac surgery-AKI is common in neonates when the AKIN definition is utilized and is associated with higher morbidity and mortality, especially in those with more severe AKI.
KeywordsAcute kidney injury Neonatal Epidemiology Cardiac surgery Acute Kidney Injury Network
- 1.Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: Effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374Google Scholar
- 4.Pedersen KR, Hjortdal VE, Christensen S, Pedersen J, Hjortholm K, Larsen SH, Povlsen JV (2008) Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl (108):S81–86Google Scholar
- 6.Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162(120–127):e121Google Scholar
- 10.Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, Devine O, Petrini J, Ramadhani TA, Hobbs CA, Kirby RS (2006) National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol 76:747–756PubMedCrossRefGoogle Scholar
- 13.Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212PubMedCrossRefGoogle Scholar
- 18.Duzova A, Bakkaloglu A, Kalyoncu M, Poyrazoglu H, Delibas A, Ozkaya O, Peru H, Alpay H, Soylemezoglu O, Gur-Guven A, Bak M, Bircan Z, Cengiz N, Akil I, Ozcakar B, Uncu N, Karabay-Bayazit A, Sonmez F (2010) Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 25:1453–1461PubMedCrossRefGoogle Scholar
- 22.Kist-van Holthe tot Echten JE, Goedvolk CA, Doornaar MB, van der Vorst MM, Bosman-Vermeeren JM, Brand R, van der Heijden AJ, Schoof PH, Hazekamp MG (2001) Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. Pediatr Cardiol 22:321–326PubMedGoogle Scholar
- 33.Liu KD, Thompson BT, Ancukiewicz M, Steingrub JS, Douglas IS, Matthay MA, Wright P, Peterson MW, Rock P, Hyzy RC, Anzueto A, Truwit JD (2011) Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes. Crit Care Med 39:2665–2671PubMedGoogle Scholar