[en] Introduction: The incidence of acute kidney injury (AKI) in pediatric patients following cardiac surgery varies between 15 and 64%, with a mortality rate of 10-89% among those requiring dialysis. This variation in the incidence and mortality of AKI across studies is probably due to the inconsistent definitions used for AKI. The purpose of this study is to present our experience with AKI post-cardiac surgery with emphasis on predisposing or aggravating factors. Patients and Methods: We evaluated the incidence of AKI using the KDIGO criteria in 150 infants and children undergoing cardiac surgeries between 2015 and 2017. Post-operatively, all patients were admitted to the pediatric intensive care unit (PICU) at a tertiary care center in a developing country. This is a retrospective chart review in which data collected included age, gender, type of heart disease, prior cardiac surgeries, RACHS-1 category, and pre- and post-operative creatinine levels. Neonates were not included in this study. Results: Six percent of the studied patients were below 1 year of age, 84% 1-10 years, and 10% 10-18 years. Fourteen patients (9.3%) developed AKI. Patients with cyanotic heart disease were more prone to develop AKI (78%) compared to those with non-cyanotic heart disease (44%). Children with AKI had a higher length of stay in PICU, 2.56 ± 1.44 vs. 4 ± 2.66 (p- 0.02). Serum lactic acid was higher in patients who developed AKI with a mean value of 6.8 ± 6.9 vs. 2.85 ± 1.55 mmol/l in the non-AKI group (p- 0.03). Lower hemoglobin levels and hyperlactic acidemia were significantly more prevalent in the AKI group. There were five deaths in this series (3.3%), and four of those (80%) were in the AKI group. Conclusion: Using the KDIGO criteria, the incidence of AKI in infants and children following cardiac surgery was 9.3%. This is slightly lower than in previously published studies where the range was between 15 and 64%. Children with cyanotic cardiac disease, hyperlactic acidemia, and anemia were more prone to developing AKI. Identifying patients at risk might help decrease the risk of post-operative AKI.
Disciplines :
Surgery Cardiovascular & respiratory systems Pediatrics
Author, co-author :
Aoun, Bilal
Daher, Ghadi Abu
Daou, Karim N.
Sanjad, Sami
Tamim, Hani
El Rassi, Issam
Arabi, Mariam
Sharara, Rana
Bitar, Fadi
ASSY, Jana ; Centre Hospitalier Universitaire de Liège - CHU > Département de Pédiatrie > Service de pédiatrie
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Bibliography
Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. (2011) 39:1493–9. 10.1097/CCM.0b013e31821201d321336114
Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine as stratified in the RIFLE score for acute kidney injury is associated with mortality and length of stay for children in the pediatric intensive care unit. Crit Care Med. (2010) 38:933–9. 10.1097/CCM.0b013e3181cd12e120124891
Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. (2012) 143:368–74. 10.1016/j.jtcvs.2011.06.02121798562
Yuan SM. Acute kidney injury after cardiac surgery. Pediatr Neonatol. (2019) 60:3–11. 10.1016/j.pedneo.2018.03.007
Morgan CJ, Zappitelli M, Robertson CMT, Alton GY, Sauve RS, Joffe AR, et al. Risk factors and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr. (2013) 162:120–7.e1. 10.1016/j.jpeds.2012.06.05422878115
Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. (2013) 17:204. 10.1186/cc1145423394211
Akcan-Arikan A, Zappitelli M, Loftis L, Washburn K, Jefferson L, Goldstein S. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. (2007) 71:1028–35. 10.1038/sj.ki.500223117396113
Greenberg JH, Zappitelli M, Devarajan P, Thiessen-Philbrook HR, Krawczeski C, Li S, et al. Kidney outcomes 5 Years after pediatric cardiac surgery: the TRIBE-AKI study. JAMA Pediatr. (2016) 170:1071–8. 10.1001/jamapediatrics.2016.153227618162
Basu RK, Wong HR, Krawczeski CD, Wheeler DS, Manning PB, Chawla LS, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol. (2014) 64:2753–62. 10.1016/j.jacc.2014.09.06625541128
Devarajan P. Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol. (2006) 17:1503–20. 10.1681/ASN.200601001716707563
Okusa MD. The inflammatory cascade in acute ischemic renal failure. Nephron. (2002) 90:133–8. 10.1159/00004903211818695
Zappitelli M, Bernier P-L, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int. (2009) 76:885–92. 10.1038/ki.2009.27019641482
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int Suppl. (2012) 2:1–138.
Lex DJ, Toth R, Cserep Z, Alexander SI, Breuer T, Sapi E, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg. (2014) 97:202–10. 10.1016/j.athoracsur.2013.09.01424206964
Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, et al. Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med. (2014) 40:1481–8. 10.1007/s00134-014-3391-825079008
Cordina RL, Celermajer DS. Chronic cyanosis and vascular function: implications for patients with cyanotic congenital heart disease. Cardiol Young. (2010) 20:242–53. 10.1017/S104795111000046620416139
Piggott KD, Soni M, Decampli WM, Ramirez JA, Holbein D, Fakioglu H, et al. Acute kidney injury and fluid overload in neonates following surgery for congenital heart disease. World J Pediatr Congenit Heart Surg. (2015) 6:401–6. 10.1177/215013511558681426180155
Sethi SK, Kumar M, Sharma R, Bazaz S, Kher V. Acute kidney injury in children after cardiopulmonary bypass: risk factors and outcome. Indian Pediatr. (2015) 52:223–6. 10.1007/s13312-015-0611-425848999
Abu-Omar Y, Ratnatunga C. Cardiopulmonary bypass and renal injury. Perfusion. (2006) 21:209–13. 10.1191/0267659106pf870oa
Skippen PW, Krahn GE. Acute renal failure in children undergoing cardiopulmonary bypass. Crit Care Resusc. (2005) 7:286–91.16539583
Amini S, Abbaspour H, Morovatdar N, Robabi HN, Soltani G, Tashnizi MA. Risk factors and outcome of acute kidney injury after congenital heart surgery: a prospective observational study. Indian J Crit Care Med. (2017) 21:847–51 10.4103/ijccm.IJCCM_459_1629307966
Cardoso B, Laranjo S, Gomes I, Freitas I, Trigo C, Fragata I, et al. Acute kidney injury after pediatric cardiac surgery: risk factors and outcomes. Proposal for a predictive model. Rev Port Cardiol. (2016) 35:99–104. 10.1016/j.repce.2016.01.00126831910
Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. (2012) 94:1589–95. 10.1016/j.athoracsur.2012.06.05022884599
Park SK, Hur M, Kim E, Kim WH, Park JB, Kim Y, et al. Risk factors for acute kidney injury after congenital cardiac surgery in infants and children: a retrospective observational study. PLoS ONE. (2016) 11:e0166328. 10.1371/journal.pone.016632827832187
Kim WH, Park MH, Kim HJ, Lim HY, Shim HS, Sohn JT, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta: a propensity score matched case-control study. Medicine. (2015) 94:e273. 10.1097/MD.000000000000027325590836
Watkins SC, Williamson K, Davidson M, Donahue BS. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery. Paediatr Anaesth. (2014) 24:919–2627. 10.1111/pan.1241924823449
Bove T, Monaco F, Covello RD, Zangrillo A. Acute renal failure and cardiac surgery. HSR Proc Intensive Care Cardiovasc Anesth. (2009) 1:13–21.
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