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. 2019 Dec;5(4):326-342.
doi: 10.1007/s40746-019-00171-6. Epub 2019 Aug 28.

Acute Kidney Injury and Fluid Overload in Pediatric Cardiac Surgery

Michael A Carlisle  1 , Danielle E Soranno  2 , Rajit K Basu  3 , Katja M Gist  4
Affiliations

Acute Kidney Injury and Fluid Overload in Pediatric Cardiac Surgery

Michael A Carlisle et al. Curr Treat Options Pediatr. 2019 Dec.

Abstract

Purpose of review: Acute kidney injury (AKI) and fluid overload affect a large number of children undergoing cardiac surgery, and confers an increased risk for adverse complications and outcomes including death. Survivors of AKI suffer long-term sequelae. The purpose of this narrative review is to discuss the short and long-term impact of cardiac surgery associated AKI and fluid overload, currently available tools for diagnosis and risk stratification, existing management strategies, and future management considerations.

Recent findings: Improved risk stratification, diagnostic prediction tools and clinically available early markers of tubular injury have the ability to improve AKI-associated outcomes. One of the major challenges in diagnosing AKI is the diagnostic imprecision in serum creatinine, which is impacted by a variety of factors unrelated to renal disease. In addition, many of the pharmacologic interventions for either AKI prevention or treatment have failed to show any benefit, while peritoneal dialysis catheters, either for passive drainage or prophylactic dialysis may be able to mitigate the detrimental effects of fluid overload.

Summary: Until novel risk stratification and diagnostics tools are integrated into routine practice, supportive care will continue to be the mainstay of therapy for those affected by AKI and fluid overload after pediatric cardiac surgery. A viable series of preventative measures can be taken to mitigate the risk and severity of AKI and fluid overload following cardiac surgery, and improve care.

Keywords: acute kidney injury; cardiac surgery; congenital heart disease; fluid overload.

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Conflict of interest statement

Conflicts of Interest There are no conflicts of interest.

Figures

Figure 1.
Figure 1.. Framework for risk stratification, improved diagnostic prediction tools and laboratory measures and treatment strategies for AKI and its complications.
In this construct, the presence of fluid overload independently and synergistically (with AKI) leads to worse outcomes. AKI = acute kidney injury, RRT = renal replacement therapy, LCOS = low cardiac output syndrome, CPB = cardiopulmonary bypass. Adapted with permission from RK Basu.
See this image and copyright information in PMC

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