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Kidney Disease: Improving Global Outcomes in neonates with acute kidney injury after cardiac surgery

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Abstract

Background

Acute kidney injury (AKI) after cardiac surgery (CS-AKI) in children with congenital heart disease is a serious complication closely associated with high morbidity and mortality. Kidney Disease: Improving Global Outcomes (KDIGO) AKI staging demonstrates high sensitivity for detecting AKI and predicting associated in-hospital mortality. However, neonatal-modified KDIGO criteria (n-KDIGO), recently introduced as a standard diagnostic tool, for CS-AKI have not been fully validated. Here, we evaluated the incidence of risk factors and postoperative outcomes of neonatal CS-AKI.

Methods

We retrospectively studied 114 consecutive neonates who underwent cardiac surgery at the Kagoshima University Hospital. CS-AKI was classified using the n-KDIGO criteria. Risk adjustment in congenital heart surgery (RACHS-1) score was used to predict the complexity-adjusted mortality and % fluid overload (%FO) was used to monitor fluid balance in pediatric cardiac surgery.

Results

Among 81 patients, neonatal CS-AKI occurred in 57 (70.4%) patients according to n-KDIGO criteria. Of these, 28 (34.6%) patients reached n-KDIGO 1, 17 (21.0%) reached n-KDIGO 2, and 12 (14.8%) reached n-KDIGO 3. Patients with CS-AKI had significantly higher vasoactive-inotropic score levels, longer operative times, and higher %FO than patients without CS-AKI. Notably, increased duration of cardiopulmonary bypass times and %FO were risk factors for the development of neonatal CS-AKI. The n-KDIGO-based severe AKI grade had higher risk of in-hospital mortality; however, the n-KDIGO-based mild AKI grade was not associated with any postoperative outcomes.

Conclusions

CS-AKI based on n-KDIGO criteria is common in neonates and is closely associated with higher mortality, especially in patients with severe CS-AKI.

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Acknowledgements

We appreciate our patients and their parents for their commitment to this project. We would like to thank Editage (www.editage.jp) for English language editing.

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Authors and Affiliations

  1. Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan

    Kentaro Ueno, Naohiro Shiokawa, Yoshihiro Takahashi, Koji Nakae, Jumpei Kawamura & Yoshifumi Kawano

  2. Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

    Yutaka Imoto

Authors
  1. Kentaro Ueno
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  2. Naohiro Shiokawa
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  3. Yoshihiro Takahashi
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  4. Koji Nakae
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  5. Jumpei Kawamura
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  6. Yutaka Imoto
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  7. Yoshifumi Kawano
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Contributions

Conceptualization: KU; methodology: KU; formal analysis and investigation: KU, NS, YT, KN, and JK; writing—original draft preparation: KU; writing—review and editing: YI, YK; supervision: YK. All the authors read and approved the final manuscripts.

Corresponding author

Correspondence to Kentaro Ueno.

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Conflict of interest

All the authors have declared no competing interest.

Ethical approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Kagoshima University Ethics Committee, 190055) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Due to the retrospective nature of this study, parental and patient informed consents were waived.

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Ueno, K., Shiokawa, N., Takahashi, Y. et al. Kidney Disease: Improving Global Outcomes in neonates with acute kidney injury after cardiac surgery. Clin Exp Nephrol 24, 167–173 (2020). https://doi.org/10.1007/s10157-019-01805-7

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  • DOI: https://doi.org/10.1007/s10157-019-01805-7

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