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. 2023 Aug;38(8):2861-2871.
doi: 10.1007/s00467-023-05925-x. Epub 2023 Mar 16.

Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients

Satoshi Kimura  1 , Kazuyoshi Shimizu  2 , Tatsuo Iwasaki  2 , Tomoyuki Kanazawa  2 , Takashi Morimatsu  2 , Takeru Hatano  3 , Hiroshi Morimatsu  2
Affiliations

Outcomes associated with unrecognized acute kidney injury in postoperative pediatric cardiac patients

Satoshi Kimura et al. Pediatr Nephrol. 2023 Aug.

Abstract

Background: The present retrospective study was carried out to determine the incidence of unrecognized cardiac surgery-associated acute kidney injury (CSA-AKI) due to infrequency of serum creatinine (SCr) measurements in pediatric cardiac patients and to assess the association between unrecognized CSA-AKI and clinical outcomes.

Methods: This study was a single-center, retrospective study of pediatric patients who underwent cardiac surgery. Patients were diagnosed with CSA-AKI based on SCr measurements, and unrecognized CSA-AKI was defined under the assumptions that there had been only one or two SCr measurements within 48 h after surgery: CSA-AKI unrecognized by one SCr measurement (AKI-URone), CSA-AKI unrecognized by two SCr measurements (AKI-URtwo), and CSA-AKI recognized by one and two SCr measurements (AKI-R). The change of SCr from baseline to postoperative day 30 (delta SCr30d) was assessed as a surrogate of kidney recovery.

Results: In a total of 557 cases, 313 patients (56.2%) were diagnosed with CSA-AKI, 188 (33.8%) of whom had unrecognized CSA-AKI. Delta SCr30d in the AKI-URtwo group and delta SCr30d in the AKI-URone group was not significantly different from delta SCr30d in the non-AKI group (p = 0.67 and p = 0.79, respectively). There were significant differences in the durations of mechanical ventilation, serum B-type natriuretic peptide levels, and lengths of stay in hospital between the non-AKI group and the AKI-URtwo group and between the non-AKI group and the AKI-URtwo group.

Conclusions: Unrecognized CSA-AKI due to infrequent SCr measurements is not rare and is associated with prolonged mechanical ventilation, high postoperative BNP level, and prolonged length of stay in hospital. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Cardiac surgery; Children; Serum creatinine measurements.

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