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Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients

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Abstract

Background

The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes.

Methods

This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery.

Results

In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group.

Conclusions

Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

CSA-AKI:

Cardiac surgery-associated acute kidney injury

AKI:

Acute kidney injury

pRIFLE:

Pediatric Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease

AKIN:

Acute Kidney Injury Network

KDIGO:

Kidney Disease Improving Global Outcomes

SCr:

Serum creatinine

PCICU:

Pediatric cardiac intensive care unit

CPB:

Cardiopulmonary bypass

SCr24h :

Serum creatinine measurement which was closest to 24 h after surgery

SCr16h :

Serum creatinine measurement which was closest to 16 h after surgery

SCr32h :

Serum creatinine measurement which was closest to 32 h after surgery

Delta SCr30d :

The change of SCr from baseline to postoperative day 30

Delta SCr180d :

The change of SCr from baseline to postoperative day 180

BNPmax :

Maximum serum B-type natriuretic peptide level for the first 30 days after surgery

IQR:

Interquartile range

pSCrAKI :

Percentage of serum creatinine measurements that met the acute kidney injury criteria in all of the serum creatinine measurements within 48 h after surgery

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Authors and Affiliations

  1. Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Satoshi Kimura, Kazuyoshi Shimizu, Tatsuo Iwasaki, Tomoyuki Kanazawa, Takashi Morimatsu & Hiroshi Morimatsu

  2. Okayama University School of Medicine, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan

    Takeru Hatano

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  1. Satoshi Kimura
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Contributions

SK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KS, TI, TK, TM, TH, and HM contributed substantially to the study design, data analysis and interpretation, and the writing of the manuscript.

Corresponding author

Correspondence to Satoshi Kimura.

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Ethics approval and consent to participate

The study protocol was approved by the Okayama University Hospital Ethics Committee. The committee waived any requirement for informed consent due to this study utilizing an existing database.

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Not applicable.

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The authors declare no competing interests.

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Supplementary Information

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Graphical Abstract (PPTX 69 KB)

Supplementary file2 (DOCX 16 KB)

Supplementary file3 (DOCX 18 KB)

467_2023_5925_MOESM4_ESM.pdf

Supplemental Figure 1. Kaplan-Meier curves. AKI, acute kidney injury; AKI-URa, acute kidney injury unrecognized by one and two serum creatinine measurements; AKI-URb, acute kidney injury unrecognized by one serum creatinine measurement but recognized by two serum creatinine measurements; AKI-URc, acute kidney injury unrecognized by two serum creatinine measurements but recognized by one serum creatinine measurement; AKI-R, acute kidney injury recognized by one and two serum creatinine measurements (PDF 9 KB)

467_2023_5925_MOESM5_ESM.pdf

Supplemental Figure 2. Histogram of the numbers of peak serum creatinine levels in hourly periods. SCr, serum creatinine (PDF 5 KB)

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Kimura, S., Shimizu, K., Iwasaki, T. et al. Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients. Pediatr Nephrol 38, 2861–2871 (2023). https://doi.org/10.1007/s00467-023-05925-x

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