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Association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery

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Abstract

Postoperative acute kidney injury (AKI) is a prevalent condition and associated with increased morbidity and mortality following cardiac surgery. This study aimed to investigate the association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery. This retrospective cohort study included patients aged from 1 month to 5 years who underwent congenital heart surgery with cardiopulmonary bypass at the Second Xiangya Hospital of Central South University from January 2016 to March 2022. On the basis of the percentile of body mass index (BMI) for age and sex, eligible participants were divided into three nutritional groups: normal bodyweight, underweight (BMI P5), and obesity (BMI P95). Primary outcomes included postoperative AKI and major adverse kidney events within 30 days (MAKE30). Multivariable logistic regression was performed to determine the association of underweight and obesity with postoperative outcomes. The same analyses were reproduced for classifying patients using weight-for-height instead of BMI. A total of 2,079 eligible patients were included in the analysis, including 1,341 (65%) patients in the normal bodyweight group, 683 (33%) patients in the underweight group, and 55 (2.6%) patients in the obesity group. Postoperative AKI (16% vs. 26% vs. 38%; P < 0.001) and MAKE30 (2.5% vs. 6.4% vs. 9.1%; P < 0.001) were more likely to occur in the underweight and obesity groups. After adjusting for potential confounders, underweight (OR1.39; 95% CI 1.08-1.79; P = 0.008) and obesity (OR 3.85; 95% CI 1.97–7.50; P < 0.001) were found to be associated with an increased risk of postoperative AKI. In addition, both underweight (OR 1.89; 95% CI 1.14–3.14; P = 0.014) and obesity (OR 3.14; 95% CI 1.08-9.09; P = 0.035) were independently associated with MAKE30. Similar results were also found when weight-for-height was used instead of BMI.

    Conclusion: In infants and young children undergoing congenital heart surgery, underweight and obesity are independently associated with postoperative AKI and MAKE30. These results may help assess prognosis in underweight and obese patients, and will guide future quality improvement efforts.

What is Known:

• Postoperative acute kidney injury (AKI) is prevalent and associated with increased morbidity and mortality following pediatric cardiac surgery.

• Major adverse kidney events within 30 days (MAKE30) have been recommended as a patient-centered endpoint for evaluating AKI clinical trajectories. A growing concern arises for underweight and obesity in children with congenital heart disease.

What is New:

• Prevalence of underweight and obesity among infants and young children undergoing congenital heart surgery was 33% and 2.6%, respectively.

• Both underweight and obesity were independently associated with postoperative AKI and MAKE30 following congenital heart surgery.

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Data availability

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

Abbreviations

AKI:

Acute kidney injury

ASA:

American Society of Anesthesiologists

BMI:

Body mass index

CHD:

Congenital heart disease

CI:

Confidence interval

CPB:

Cardiopulmonary bypass

eGFR:

Estimated glomerular filtration rate

ICU:

Intensive care unit

IQR:

Interquartile range

KDIGO:

Kidney Disease: Improving Global Outcomes

MAKE30:

Major adverse kidney events within 30 days

OR:

Odds ratio

RACHS-1:

Adjustment for Congenital Heart Surgery-1

RRT:

Renal replacement therapy

SCr:

Serum creatinine

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Acknowledgements

The authors would like to acknowledge Zhan-Yi Shi (Xiangya School of Medicine, Central South University) for her expert linguistic instruction provided. The authors would like to express their gratitude to EditSprings (https://www.editsprings.cn) for the expert linguistic services provided.

Funding

This study was supported by National Natural Science Foundation of China (No.81873607).

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Author notes

  1. Yi-Xin Kang and Xiao-Qin Luo authors contributed equally to this work.

Authors and Affiliations

  1. Department of Nephrology, The Second Xiangya Hospital of Central South University, Hunan Key Laboratory of Kidney Disease and Blood Purification, 139 Renmin Road, Changsha, 410011, Hunan, China

    Yi-Xin Kang, Xiao-Qin Luo, Ping Yan & Shao-Bin Duan

  2. Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Si-Jie Wu & Guo-Bao Song

  3. Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China

    Ning-Ya Zhang

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Contributions

S-BD designed and supervised the study and revised the manuscript. Y-XK and X-QL performed the data extraction, analyzed and interpreted the data and drafted the manuscript. N-YZ performed the data extraction and critically revised the manuscript for important intellectual content. S-JW, G-BS, and PY and interpreted the data and critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shao-Bin Duan.

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Ethics approval

The Medical Ethics Committee of the Second Xiangya Hospital of Central South University approved the study protocol and waived the informed consent (2022-K031). This study has also been registered in the Chinese Clinical Trial Registry (ChiCTR2200061610). The research was carried out in line with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

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Communicated by Gregorio Milani.

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Kang, YX., Luo, XQ., Zhang, NY. et al. Association of underweight and obesity with adverse postoperative renal outcomes in infants and young children undergoing congenital heart surgery. Eur J Pediatr 182, 3691–3700 (2023). https://doi.org/10.1007/s00431-023-05041-w

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