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Acute kidney injury and kidney recovery after cardiopulmonary bypass in children

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Abstract

Background

Acute kidney injury (AKI) that improves in the pediatric intensive care unit (PICU) is associated with better outcomes compared to AKI that persists, but no study has investigated whether this also occurs in children undergoing cardiopulmonary bypass (CPB).

Methods

A retrospective study of children ≤18 years who underwent CPB in three children’s hospitals was conducted. Patients were classified into groups by kidney recovery after AKI according to Acute Disease Quality Initiative (ADQI) guidelines. Adjusted regression models evaluated associations between kidney recovery group and hospital outcomes.

Results

Among 3620 children, AKI developed in 701 (19.4%): 610 transient AKI, 47 persistent AKI, and 44 acute kidney disease (AKD). Mortality increased with severity of kidney recovery group: 4.5% in the never developed AKI group, 8.9% in the transient AKI group, 25.5% in the persistent AKI group, and 31.8% in the AKD group (p <0.0001). In adjusted analysis, transient AKI (HR 1.4, CI 1.02, 2), persistent AKI (HR 22.4, CI 10.2, 49.2), and AKD (HR 3.7, CI 1.7, 7.9) had a greater hazard of mortality when compared to the never developed AKI group. Patients with transient AKI had a longer length of PICU stay than those with never developed AKI (HR 5.1, CI 2.9, 7.3).

Conclusions

Patterns of kidney recovery after AKI were associated with worse PICU outcomes in children after CPB compared to those who did not develop AKI, even after rapid AKI recovery. Identification of factors that increase risk for these AKI patterns is necessary for prevention of AKI during CPB in children.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Cohen Children’s Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA

    Michael LoBasso & Christine B. Sethna

  2. Division of Pediatric Critical Care, Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA

    James Schneider

  3. Division of Critical Care, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    L. Nelson Sanchez-Pinto

  4. Division of Critical Care, Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Sylvia Del Castillo, Gina Kim & Alysia Flynn

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  1. Michael LoBasso
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  2. James Schneider
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  3. L. Nelson Sanchez-Pinto
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  4. Sylvia Del Castillo
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  5. Gina Kim
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  7. Christine B. Sethna
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Correspondence to Christine B. Sethna.

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LoBasso, M., Schneider, J., Sanchez-Pinto, L.N. et al. Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol 37, 659–665 (2022). https://doi.org/10.1007/s00467-021-05179-5

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  • DOI: https://doi.org/10.1007/s00467-021-05179-5

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