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Cardiac surgery-associated acute kidney injury in a developing country: Prevalence, risk factors and outcome
Ekanem Nsikak Ekure1, Christopher Imokhuede Esezobor, Anuradha Sridhar
1Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.
Insights
Cardiac surgery-associated acute kidney injury (CS-AKI) affects 12.1% of pediatric patients in India. This condition, linked to sepsis and hypotension, significantly increases mortality and hospital resource use.
Area of Science:
- Pediatric Nephrology
- Pediatric Cardiology
- Critical Care Medicine
Background:
- Cardiac surgery-associated acute kidney injury (CS-AKI) is a significant concern in pediatric patients.
- Data on CS-AKI prevalence and outcomes in developing regions remain scarce.
- Understanding CS-AKI in this population is crucial for improving patient care and resource allocation.
Purpose of the Study:
- To determine the prevalence of CS-AKI in children undergoing cardiac surgery in India.
- To identify factors associated with CS-AKI development.
- To evaluate the impact of CS-AKI on in-hospital mortality and hospital service utilization.
Main Methods:
- Retrospective review of hospital records for children (0-17 years) undergoing cardiac surgery.
- CS-AKI definition: serum creatinine rise ≥0.3 mg/dL or urine output <0.5 mL/kg/h within 5 days post-surgery.
- Data analysis included prevalence, associated factors, mortality, and resource utilization.
Main Results:
- CS-AKI occurred in 12.1% of 323 pediatric patients.
- Associated factors included sepsis and intra/post-operative hypotension.
- CS-AKI was linked to a six-fold increase in in-hospital mortality and extended ICU/mechanical ventilation stays.
Conclusions:
- CS-AKI is present in pediatric cardiac surgery patients in developing countries, albeit at a lower frequency.
- Sepsis and hypotension are key risk factors for CS-AKI.
- CS-AKI significantly elevates mortality risk and healthcare resource consumption in pediatric cardiac surgery patients.
Abstract:
Little is known about cardiac surgery-associated acute kidney injury (CS-AKI) in children in developing regions of the world. The study aimed to determine the prevalence of CSAKI, associated factors and its impact on mortality and utilization of hospital services. The hospital records of children aged 0-17 years who underwent CS at an Indian hospital were reviewed. CS-AKI was defined as a rise in serum creatinine of ≥0.3 mg/dL in any 48 h and or by urine output <0.5 mL/kg/h for an 8-h period in the first five days after CS. The study included 323 children with a median age of one year (0.04-17), of whom 22 (6.8%) were neonates and 18.3% had a single ventricle. About 60% of the children had Risk Adjusted Congenital Heart Surgery-I category 1 or 2 interventions. CS-AKI occurred in 39 children (12.1%). Factors associated with CS-AKI were sepsis and intraand post-operative hypotension. In-hospital mortality was six-fold higher in children who developed CS-AKI. CS-AKI was associated with two to three days more of mechanical ventilation and Intensive care unit stay. CS-AKI occurs in children in developing countries, but at a lower frequency mainly due to the predominance of post-neonatal children undergoing less-complex CSs. CS-AKI was associated with higher in-hospital mortality and increased utilization of hospital services. Factors associated with CS-AKI included intraand post-operative hypotension and sepsis.
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