Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study

Abstract

Objective: To determine the incidence, severity, and risk factors of acute kidney injury in children undergoing cardiac surgery for congenital heart defects.

Design: Prospective observational multicenter cohort study.

Setting: Three pediatric intensive care units at academic centers.

Patients: Three hundred eleven children between the ages of 1 month and 18 yrs undergoing pediatric cardiac surgery.

Interventions: None.

Measurements and main results: Acute kidney injury was defined as a ≥50% increase in serum creatinine from the preoperative value. Secondary outcomes were length of mechanical ventilation, length of intensive care unit and hospital stays, acute dialysis, and in-hospital mortality. The cohort had an average age of 3.8 yrs and was 45% women and mostly white (82%). One-third had prior cardiothoracic surgery, 91% of the surgeries were elective, and almost all patients required cardiopulmonary bypass. Acute kidney injury occurred in 42% (130 patients) within 3 days after surgery. Children ≥2 yrs old and <13 yrs old had a 72% lower likelihood of acute kidney injury (adjusted odds ratio: 0.28, 95% confidence interval: 0.16, 0.48), and patients 13 yrs and older had 70% lower likelihood of acute kidney injury (adjusted odds ratio: 0.30, 95% confidence interval: 0.10, 0.88) compared to patients <2 yrs old. Longer cardiopulmonary bypass time was linearly and independently associated with acute kidney injury. The development of acute kidney injury was independently associated with prolonged ventilation and with increased length of hospital stay.

Conclusions: Acute kidney injury is common after pediatric cardiac surgery and is associated with prolonged mechanical ventilation and increased hospital stay. Cardiopulmonary bypass time and age were independently associated with acute kidney injury risk. Cardiopulmonary bypass time may be a marker for case complexity.

Figure 1

Study population. TRIBE-AKI, Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury

Figure 2

Characteristics of acute kidney injury in pediatric heart surgery. AKI, acute kidney injury

Figure 3

Multivariable adjusted odds ratios for acute kidney injury are shown according to bypass time in increasing intervals from 60 minutes. The analysis included age, RACHS-1 score and site. Adj, adjusted; RACHS-1, Risk Adjustment for Congenital Heart Surgery 1.