Predictors of acute kidney injury post-cardiopulmonary bypass in children

Area of Science:

• Pediatric critical care medicine
• Cardiothoracic surgery
• Nephrology

Background:

• Acute kidney injury (AKI) is a significant complication following cardiopulmonary bypass (CPB) in pediatric patients.
• Understanding the incidence, risk factors, and outcomes of AKI post-CPB is crucial for improving patient care in pediatric cardiothoracic intensive care units (ICUs).

Purpose of the Study:

• To determine the incidence of AKI after CPB in children admitted to a pediatric cardiothoracic ICU.
• To identify factors associated with the development of AKI post-CPB.
• To evaluate the outcomes, including mortality and need for renal replacement therapy, in pediatric patients who develop AKI after CPB.

Main Methods:

• Retrospective review of 124 children (<18 years) who underwent CPB between January 2007 and December 2009 in a 10-bed cardiothoracic ICU.
• Data collected included demographics, baseline and postoperative laboratory values (hemoglobin, leukocytes, platelets, urea, creatinine), urine output, inotrope use, and CPB duration.
• Postoperative cardiac, renal, hepatic, neurologic, and respiratory dysfunctions were recorded.

Main Results:

• Overall incidence of AKI was 11% (Stage I: 5%, Stage II: 4%, Stage III: 2%).
• Significant risk factors for AKI included younger age (<1 year), weight <10 kg, pump failure, sepsis, and CPB duration >90 minutes.
• Patients with AKI experienced longer hospital stays and increased mortality; all Stage III AKI patients died. Two patients required dialysis, and none developed chronic renal impairment.

Conclusions:

• AKI is a common complication in pediatric patients following CPB, occurring in 11% of cases.
• While AKI is frequent, the need for renal replacement therapy is uncommon.
• Younger age, lower weight, pump failure, sepsis, and prolonged CPB are identified as significant risk factors for AKI development.