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12.08.2021 | Original Article

Acute kidney injury and kidney recovery after cardiopulmonary bypass in children

verfasst von: Michael LoBasso, James Schneider, L. Nelson Sanchez-Pinto, Sylvia Del Castillo, Gina Kim, Alysia Flynn, Christine B. Sethna

Erschienen in: Pediatric Nephrology | Ausgabe 3/2022

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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.

Graphical abstract

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Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, Schneider J (2012) Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94:1589–1595. https://doi.org/10.1016/j.athoracsur.2012.06.050CrossRefPubMed

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 162:120–7.e1. https://doi.org/10.1016/j.jpeds.2012.06.054CrossRefPubMed

Schneider J, Khemani R, Grushkin C, Bart R (2010) 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 38:933–939. https://doi.org/10.1097/CCM.0b013e3181cd12e1CrossRefPubMed

Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, Kim RW, Parikh CR, TRIBE-AKI Consortium (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39:1493–1499. https://doi.org/10.1097/CCM.0b013e31821201d3CrossRefPubMedPubMedCentral

Brown JR, Cochran RP, TA MK, Furnary AP, Kunzelman KS, Ross CS, Langner CW, Charlesworth DC, Leavitt BJ, Dacey LJ, Helm RE, Braxton JH, Clough RA, Dunton RF, O’Connor GT, Northern New England Cardiovascular Disease Study Group (2008) Long-term survival after cardiac surgery is predicted by estimated glomerular filtration rate. Ann Thorac Surg 86:4–11. https://doi.org/10.1016/j.athoracsur.2008.03.006CrossRefPubMed

Singh SP (2016) Acute kidney injury after pediatric cardiac surgery. Ann Card Anaesth 19:306–313. https://doi.org/10.4103/0971-9784.179635CrossRefPubMedPubMedCentral

Pedersen KR, Povlsen JV, Christensen S, Pedersen J, Hjortholm K, Larsen SH, Hjortdal VE (2007) Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand 51:1344–1349. https://doi.org/10.1111/j.1399-6576.2007.01379.xCrossRefPubMed

Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O (2009) A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 76:885–892. https://doi.org/10.1038/ki.2009.270CrossRefPubMed

Shaffner DH, Nichols DG (2015) Rogers’ textbook of pediatric intensive care. LWW

10.

Swaminathan M, Hudson CC, Phillips-Bute BG, Patel UD, Mathew JP, Newman MF, Milano CA, Shaw AD, Stafford-Smith M (2010) Impact of early renal recovery on survival after cardiac surgery-associated acute kidney injury. Ann Thorac Surg 89:1098–1104. https://doi.org/10.1016/j.athoracsur.2009.12.018CrossRefPubMed

11.

Bagshaw SM, Mortis G, Godinez-Luna T, Doig CJ, Laupland KB (2006) Renal recovery after severe acute renal failure. Int J Artif Organs 29:1023–1030. https://doi.org/10.1177/039139880602901102CrossRefPubMed

12.

Spurney RF, Fulkerson WJ, Schwab SJ (1991) Acute renal failure in critically ill patients: prognosis for recovery of kidney function after prolonged dialysis support. Crit Care Med 19:8–11. https://doi.org/10.1097/00003246-199101000-00007CrossRefPubMed

13.

Lassnigg A, Schmidlin D, Mouhieddine M, Bachmann LM, Druml W, Bauer P, Hiesmayr M (2004) Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study. J Am Soc Nephrol 15:1597–1605. https://doi.org/10.1097/01.asn.0000130340.93930.ddCrossRefPubMed

14.

Sanchez-Pinto LN, Goldstein SL, Schneider JB, Khemani RG (2015) Association between progression and improvement of acute kidney injury and mortality in critically ill children. Pediatr Crit Care Med 16:703–710. https://doi.org/10.1097/PCC.0000000000000461CrossRefPubMed

15.

Hollander SA, Cantor RS, Sutherland SM, Koehl DA, Pruitt E, McDonald N, Kirklin JK, Ravekes WJ, Ameduri R, Chrisant M, Hoffman TM, Lytrivi ID, Conway J (2019) Renal injury and recovery in pediatric patients after ventricular assist device implantation and cardiac transplant. Pediatr Transplant 23:e13477. https://doi.org/10.1111/petr.13477CrossRefPubMed

16.

Hollander SA, Montez-Rath ME, Axelrod DM, Krawczeski CD, May LJ, Maeda K, Rosenthal DN, Sutherland SM (2016) Recovery from acute kidney injury and CKD following heart transplantation in children, adolescents, and young adults: a retrospective cohort study. Am J Kidney Dis 68:212–218. https://doi.org/10.1053/j.ajkd.2016.01.024CrossRefPubMed

17.

Kellum JA, Lameire N, KDIGO AKI Guideline Work Group (2013) Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17:204–215. https://doi.org/10.1186/cc11454CrossRefPubMedPubMedCentral

18.

Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, Bittleman D, Cruz D, Endre Z, Fitzgerald RL, Forni L, Kane-Gill SL, Hoste E, Koyner J, Liu KD, Macedo E, Mehta R, Murray P, Nadim M, Ostermann M, Palevsky PM, Pannu N, Rosner M, Wald R, Zarbock A, Ronco C, Kellum JA, Acute Disease Quality Initiative Workgroup 16 (2017) Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 13:241–257CrossRef

19.

Jetton JG, Askenazi DJ (2012) Update on acute kidney injury in the neonate. Curr Opin Pediatr 24:191–196. https://doi.org/10.1097/MOP.0b013e32834f62d5CrossRefPubMedPubMedCentral

20.

Lassnigg A, Schmid ER, Hiesmayr M, Falk C, Druml W, Bauer P, Schmidlin D (2008) Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med 36:1129–1137. https://doi.org/10.1097/CCM.0b013e318169181aCrossRefPubMed

21.

Sood MM, Shafer LA, Ho J, Reslerova M, Martinka G, Keenan S, Dial S, Wood G, Rigatto C, Kumar A, Cooperative Antimicrobial Therapy in Septic Shock (CATSS) Database Research Group (2014) Early reversible acute kidney injury is associated with improved survival in septic shock. J Crit Care 29:711–717. https://doi.org/10.1016/j.jcrc.2014.04.003CrossRefPubMed

22.

Brown JR, Kramer RS, Coca SG, Parikh CR (2010) Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg 90:1142–1148. https://doi.org/10.1016/j.athoracsur.2010.04.039CrossRefPubMed

23.

Mehta S, Chauhan K, Patel A, Patel S, Pinotti R, Nadkarni GN, Parikh CR, Coca SG (2018) The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol 19:91–10. https://doi.org/10.1186/s12882-018-0876-7CrossRefPubMedPubMedCentral

Titel: Acute kidney injury and kidney recovery after cardiopulmonary bypass in children
verfasst von: Michael LoBasso
James Schneider
L. Nelson Sanchez-Pinto
Sylvia Del Castillo
Gina Kim
Alysia Flynn
Christine B. Sethna
Publikationsdatum: 12.08.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Nephrology / Ausgabe 3/2022
Print ISSN: 0931-041X
Elektronische ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-021-05179-5

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Acute kidney injury and kidney recovery after cardiopulmonary bypass in children