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Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis

  • Systematic Review/Meta-analysis
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Cardiac surgery-associated acute kidney injury (AKI) is associated with increased morbidity and mortality in both adults and children.

Objectives

This study aimed to identify clinical risk factors for AKI following cardiac surgery in the pediatric population.

Data sources

PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020.

Study eligibility criteria

Studies were included if (1) the population consisted of pediatric patients (< 18 years old), (2) patients underwent cardiac surgery, (3) risk factors were compared between patients who developed AKI and those who did not, and (4) studies were prospective or retrospective observational studies or randomized controlled trials.

Participants and interventions

Children undergoing pediatric cardiac surgery.

Study appraisal and synthesis methods

Random-effects meta-analysis was performed, comparing potential risk factors between pediatric patients who developed CS-AKI and those who did not.

Results

Sixty-one publications including a total of 19,680 participants (AKI: 7257 participants; no AKI: 12,423 participants) were included from studies published between 2008 and 2020. The pooled estimated incidence of AKI was 34.3% (95% confidence interval 30.0–38.8%, I2 = 96.8%). Binary risk factors that were significantly and consistently associated with AKI were the presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, risk adjustment for congenital heart surgery 1 (RACHS-1) score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis. Significant continuous risk factors included younger age, lower body weight, lower preoperative creatinine, higher preoperative estimated glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery time, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and higher red blood cell transfusion volume.

Limitations

Results are limited by heterogeneity and potential residual confounding.

Conclusions and implications of key findings

Our meta-analysis identified clinical risk factors that are associated with AKI in children undergoing cardiac surgery. This might help clinicians anticipate and manage more carefully this population and implement standardized preventive strategies.

Systematic review registration number

CRD42021262699.

Graphical abstract

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

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

The code used for this study will be made available from the corresponding author, upon reasonable request.

Abbreviations

AKI:

Acute kidney injury

AKIN:

Acute kidney injury network

CI:

Confidence interval

CPB:

Cardiopulmonary bypass

eCrCl:

Estimated creatinine clearance

eGFR:

Estimated glomerular filtration rate

KDIGO:

Kidney disease improving global outcomes

MD:

Mean difference

MOOSE:

Meta-analysis of observational studies in epidemiology

OR:

Odds ratio

PRISMA:

Preferred reporting items for systematic reviews meta-analyses

PROSPERO:

International prospective register of systematic reviews

RACHS-1:

Risk adjustment for congenital heart surgery 1

RIFLE:

Risk for renal dysfunction, Injury to the kidney, failure of kidney function, loss of kidney function and end-stage renal disease

SCr:

Serum creatinine

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Acknowledgements

J. Van den Eynde was supported by the Belgian American Educational Foundation.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA

    Jef Van den Eynde & Shelby Kutty

  2. Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium

    Jef Van den Eynde, Boris Delpire, Xander Jacquemyn, Ismat Pardi & Marc Gewillig

  3. Faculty of Medicine, Radboud University, Nijmegen, The Netherlands

    Hajar Rotbi

  4. Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands

    Hajar Rotbi

  5. Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium

    Marc Gewillig

  6. Department of Pediatric Nephrology, University Hospitals of Leuven, Leuven, Belgium

    Djalila Mekahli

  7. PKD Research Group, GPURE, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Djalila Mekahli

Authors
  1. Jef Van den Eynde
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  2. Boris Delpire
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Contributions

JVDE: Conceptualization; Data curation; Formal analysis; Investigation; Methodology; Project administration; Software; Validation; Visualization; Writing—original draft; Writing—review & editing. BD: Conceptualization; Data curation; Investigation; Writing—original draft; Writing—review & editing. XJ: Conceptualization; Data curation; Investigation; Writing—original draft; Writing—review & editing. IP: Conceptualization; Data curation; Investigation; Writing—original draft; Writing—review & editing. HR: Conceptualization; Data curation; Investigation; Writing—original draft; Writing—review & editing. MG: Conceptualization; Investigation; Supervision; Writing—review & editing. SK: Conceptualization; Investigation; Supervision; Writing—review & editing. DM: Conceptualization; Investigation; Supervision; Writing—review & editing.

Corresponding author

Correspondence to Jef Van den Eynde.

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Conflict of interest

M. Gewillig is proctor for Edwards and Medtronic. S. Kutty is consultant for GE Healthcare. All other authors declare that they have no competing interests.

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Van den Eynde, J., Delpire, B., Jacquemyn, X. et al. Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis. Pediatr Nephrol 37, 509–519 (2022). https://doi.org/10.1007/s00467-021-05297-0

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