Skip to main content
SpringerLink
Log in

Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Acute kidney injury (AKI) is a common complication of congenital heart diseases (CHDs) after cardiac surgery. This study aimed to define the frequency and critical course, risk factors and short-term outcomes of AKI in postoperative CHD neonates.

Methods

Postoperatively followed term CHD newborn infants were enrolled in the study. Infants with congenital anomalies of the urinary tract and other major congenital anomalies were excluded. Neonatal modified KDIGO criteria were used to assess AKI.

Results

A total of 199 postoperatively followed newborn infants were included in the study. Acute kidney injury was detected in 71 (35.6%) patients. Of these patients, 24 (33.8%) were in stage 1, 14 (19.7%) in stage 2, and 33 (46.5%) in stage 3. Acute kidney injury occurred within the first week (median 1 day [IQR 1–2 days]) of cardiac surgery in 93% of the patients. The duration of invasive respiratory support and extracorporeal membrane oxygenation (ECMO) and mortality were significantly higher in stage 3 patients. Higher vasoactive-inotropic score (OR, 1.02; 95% CI, 1.0–1.04; p = 0.008) and receiving ECMO (OR, 7.9; 95% CI, 2.6–24.4; p = 0.001) were associated with risk for the development of AKI. The mortality rate was 52.1% in the AKI (+) patients, and having AKI (OR 7.1; 95% CI, 3.5–14.18) was significantly associated with mortality.

Conclusion

Acute kidney injury, a common early complication after critical neonatal CHD cardiac surgery, is associated with increased morbidity and mortality. Stage 3 AKI is associated with significantly higher mortality rates.

Graphical Abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention (CDC) (2010) Racial differences by gestational age in neonatal deaths attributable to congenital heart defects---United States, 2003-2006. MMWR Morb Mortal Wkly Rep 59:1208–1211

    Google Scholar 

  2. Abouk R, Grosse SD, Ailes EC, Oster ME (2017) Association of US state implementation of newborn screening policies for critical congenital heart disease with early infant cardiac deaths. JAMA 318:2111–2118

    Article  Google Scholar 

  3. Nada A, Bonachea EM, Askenazi D (2017) Acute kidney injury in the fetus and neonate. Semin Fetal Neonatal Med 22:90–97

    Article  Google Scholar 

  4. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL (2015) Neonatal acute kidney injury. Pediatrics 136:e463–e473

    Article  Google Scholar 

  5. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, Chisthti AS, Woroniecki R, Mammen C, Swanson JR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, Neonatal Kidney Collaborative (NKC) (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194

    Article  Google Scholar 

  6. Hongsawong N, Khamdee P, Silvilairat S, Chartapisak W (2017) Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease. Pediatr Nephrol 33:493–501

    Article  Google Scholar 

  7. Gist KM, Kwiatkowski DM, Cooper DS (2018) Acute kidney injury in congenital heart disease. Curr Opin Cardiol 33:101–107

    Article  Google Scholar 

  8. Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM, Western Canadian Complex Pediatric Therapies Follow-Up Group (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162:120–127

    Article  Google Scholar 

  9. 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 Thoracic Cardiovasc Surg 143:368–374

    Article  Google Scholar 

  10. Yuan SM (2019) Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol 60:3–11

    Article  Google Scholar 

  11. Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA (2018) Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective chort study. Pediatr Nephrol 33:1617–1624

    Article  Google Scholar 

  12. Zappitelli M, Ambalavanan N, Askenazi DJ, Moxey-Mims MM, Kimmel PL, Star RA, Abitol CL, Brophy PD, Hidalgo G, Hanna M, Morgan CM, Raju TNK, Ray P, Reyes-Bou Z, Roushdi A, Goldstein SL (2017) Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 82:569–573

    Article  Google Scholar 

  13. O’Brien SM, Clarke DR, Jacobs JP, Jacobs ML, Lacour-Gayet FG, Pizarro C, Welke KF, Maruszewski B, Tobota Z, Miller WJ, Hamilton L, Peterson ED, Mavroudis C, Edwards FH (2009) An empirically based tool for analysing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 138:1139–1153

    Article  Google Scholar 

  14. Gaies MG, Jeffries HE, Niebler RA, Pasquali SK, Donohue JE, Yu S, Gall C, Rice TB, Thiagarajan RR (2014) Vasoactive-inotropic score is associated with outcome after infant cardiac surgery: An analysis from the pediatric cardiac critical care consortium and virtual PICU system registries. Pediatr Crit Care Med 15:529–537

    Article  Google Scholar 

  15. Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, Blatt NB, Luckritz K, Hieber S, Gajarski R, Kershaw DB, Shanley TP, Gipson DS (2014) Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 40:1481–1488

    Article  Google Scholar 

  16. Li D, Niu Z, Huang Q, Sheng W, Wang T (2020) A meta-analysis of the incidence rate of postoperative acute kidney injury in patients with congenital heart disease. BMC Nephrol 21:350

    Article  Google Scholar 

  17. Dilli D, Akduman H, Orun UA, Taşar M, Tasoglu I, Aydogan S, Citli R, Tak S (2019) Predictive value of vasoactive-inotropic score for mortality in newborn undergoing cardiac surgery. Indian Pediatr 56:735–740

    Article  Google Scholar 

  18. Graziani MP, Moser M, Bozzola CM, Galvez HM, Garrido JI, Alvarez PG, Fernie ML (2019) Acute kidney injury in children after cardiac syrgery: risk factors and outcomes. A retrospective, cohort study. Arch Argent Pediatr 117:e557–e567

    PubMed  Google Scholar 

  19. SooHoo MM, Patel SS, Jaggers J, Fraubel S, Gist KM (2018) Acute Kidney Injury Defined by Fluid Corrected Creatinine in Neonates After the Norwood Procedure. World J Pediatr Congenit Heart Surg 9:513–521

  20. Kumar TK, Allen J, Spentzas T, Berrios L, Shah S, Joshi VM, Ballweg JA, Knott-Craig CJ (2016) Acute kidney injury following cardiac surgery in neonates and young infants: experience of a single center using novel perioperative strategies. World J Pediatr Congenit Heart Surg 7:460–466

  21. Charlton JR, Boohaker L, Askenazi D, Brophy PD, D’Angio C, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Smith A, Starr M, Kent AL, on behalf of the Neonatal Kidney Collaborative (2019) Incidence and risk factors of early onset neonatal AKI. Clin J Am Soc Nephrol 14:184–195

    Article  Google Scholar 

  22. Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ (2003) Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med 31:28–33

    Article  Google Scholar 

  23. Greenberg JH, Zappitelli M, Devarajan P, Thiessen-Philbrook HR, Krawczeski C, Li S, Garg AX, Coca S, Parikh CR, TRIBE-AKI Consortium (2016) Kidney outcomes 5 years after pediatric cardiac surgery: The TRIBE-AKI study. JAMA Pediatr 170:1071–1078

    Article  Google Scholar 

  24. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 59:523–530

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Serdar Beken and Burcu Bulum Akbulut contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, Neonatology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey

    Serdar Beken & Ayşe Korkmaz

  2. Department of Pediatrics, Pediatric Nephrology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey

    Burcu Bulum Akbulut

  3. Neonatal Intensive Care Unit, Acıbadem Mehmet Ali Aydınlar University, Atakent Hospital, İstanbul, Turkey

    Eda Albayrak & Yasemin Ünlü

  4. Department of Pediatrics, Acıbadem University School of Medicine, İstanbul, Turkey

    Bengisu Güner

  5. Department of Cardiovascular Surgery, Acıbadem University School of Medicine, İstanbul, Turkey

    Bahar Temur, Selim Aydin & Ersin Erek

  6. Department of Pediatrics Pediatric Cardiology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey

    Ender Ödemiş

Authors
  1. Serdar Beken
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Burcu Bulum Akbulut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eda Albayrak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bengisu Güner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yasemin Ünlü
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bahar Temur
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Selim Aydin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ender Ödemiş
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ersin Erek
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ayşe Korkmaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Serdar Beken.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(DOCX 26 kb)

ESM 2

(DOCX 13 kb)

ESM 3

(PPTX 93 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Beken, S., Akbulut, B.B., Albayrak, E. et al. Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery. Pediatr Nephrol 36, 1923–1929 (2021). https://doi.org/10.1007/s00467-020-04890-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-020-04890-z

Keywords

Search

Navigation