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. 2024 Oct 26:12:100348.
doi: 10.1016/j.bjao.2024.100348. eCollection 2024 Dec.

Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study

Takanobu Sakura  1 , Tomoyuki Kanazawa  1 , Tatsuhiko Shimizu  1 , Kazuyoshi Shimizu  1 , Tatsuo Iwasaki  1 , Hiroshi Morimatsu  1
Affiliations

Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study

Takanobu Sakura et al. BJA Open. .

Abstract

Background: Acute kidney injury (AKI) is a common complication among patients requiring cardiopulmonary bypass (CPB) during paediatric cardiac surgery. Plasma-free haemoglobin (PFH) produced by haemolysis during CPB contributes to AKI. This study aimed to determine the association between PFH and postoperative AKI during paediatric cardiac surgery requiring CPB.

Methods: This prospective, single-centre, observational study included children aged <5 yr who underwent cardiac surgery requiring CPB. PFH was measured pre-CPB, every 30 min during CPB, after modified ultrafiltration, on ICU admission, and once a day at 1-3 days after surgery. The study outcome included the relationship between peak PFH concentrations and the development of postoperative AKI up to 3 days after surgery. Additionally, multivariable analysis was performed to determine the risk factors for AKI.

Results: Of 179 patients, 74 (41%) developed postoperative AKI. Patients who developed AKI had significantly higher peak PFH concentrations (80 mg dl-1 [inter-quartile range, 50-132.5] vs 60 mg dl-1 [40-100]; P=0.006). Multivariable analysis did not identify peak PFH concentrations as an independent risk factor for postoperative AKI (odds ratio [OR] 1.00; 95% confidence interval [CI]: 0.99-1.00; P=0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94-0.99; P=0.007) and CPB duration (OR 1.02; 95% CI: 1.01-1.02; P<0.001).

Conclusions: There was an association between postoperative AKI and CPB time rather than PFH. Perioperative peak PFH concentrations were significantly higher in patients with postoperative AKI after paediatric cardiac surgery requiring CPB.

Keywords: acute kidney injury; cardiopulmonary bypass; observational study; paediatric cardiac surgery; plasma-free haemoglobin.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig 1
Fig 1
Study flow chart. CPB, cardiopulmonary bypass; ECMO, extracorporeal membrane oxygenation
Fig 2
Fig 2
Changes in plasma-free haemoglobin (PFH). AKI, acute kidney injury; CPB, cardiopulmonary bypass; POD, postoperative day
See this image and copyright information in PMC

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References

    1. Pedersen K. Acute kidney injury in children undergoing surgery for congenital heart disease. Eur J Pediatr Surg. 2012;22:426–433. - PubMed
    1. Li S., Krawczeski C.D., Zappitelli M., et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39:1493–1499. - PMC - PubMed
    1. LoBasso M., Schneider J., Sanchez-Pinto L.N., et al. Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol. 2022;37:659–665. - PubMed
    1. Aydin S.I., Seiden H.S., Blaufox A.D., et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. 2012;94:1589–1595. - PubMed
    1. Morgan C.J., Zappitelli M., Robertson C.M.T., et al. Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr. 2013;162:120–127.e1. - PubMed

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