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[Risk factors associated with postoperative acute renal failure in pediatric patients undergoing cardiopulmonary
Elsa Nohemí Reyes-Flandes1, Alejandro Herrera-Landero2, Pascual Bobadilla-González1
1Servicio de Terapia Intensiva, Instituto Mexicano del Seguro Social, Hospital de Pediatría Centro Médico Nacional Siglo XXI, Ciudad de México, México.
Insights
Pediatric patients undergoing heart surgery with cardiopulmonary bypass face risks of acute renal failure (ARF). High intraoperative lactate levels and cyanotic heart disease significantly increase ARF risk.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute renal failure (ARF) is a significant complication following cardiac surgery with cardiopulmonary bypass (CPB).
- ARF in this pediatric population is associated with increased morbidity and mortality.
- Identifying specific risk factors is crucial for timely intervention.
Purpose of the Study:
- To identify risk factors for postoperative ARF in children undergoing cardiac surgery with CPB.
- Utilize the pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) scale for ARF classification.
Main Methods:
- Nested case-control study design.
- Included pediatric patients (<16 years) undergoing CPB.
- Cases developed ARF per pRIFLE criteria; controls did not.
- Logistic regression analysis to determine odds ratios (OR) and 95% confidence intervals (95% CI).
Main Results:
- Analyzed 91 patients (31 cases, 60 controls).
- Independent risk factors for ARF included intraoperative lactate > 6 mmol/l (OR = 4.91) and cyanotic heart disease (OR = 3.62).
- Statistical significance observed for both factors (p = .02 and p = .03, respectively).
Conclusions:
- Pediatric patients with intraoperative lactate levels > 6 mmol/l during CPB are at high risk for ARF.
- Children with cyanotic congenital heart disease represent another high-risk subgroup for ARF post-cardiac surgery.
- Close monitoring of these high-risk groups is essential for prevention and timely management of ARF.
Abstract:
Acute renal failure (ARF) is a complication associated with cardiac surgery with cardiopulmonary bypass (CPB) with an impact on morbidity and mortality.
Objective:
To identify risk factors associated with postoperative IRA according to pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease scale in children undergoing cardiac surgery with CPB.
Patients And Method:
A nested case-control study was conducted. We included children under 16 years of age attended postoperative for CBP in a pediatric intensive care unit over a period of 18 months. The cases were those who developed ARF according to the classification pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease scale during their stay in the pediatric intensive care unit. Controls were those who did not develop this complication. Logistic regression analysis was performed and adjusted odds ratio (OR) and confidence intervals at 95% (95% CI) were calculated.
Results:
91 patients (31 cases and 60 controls) with a median age of 20 months and predominance of males (53.8%) were analyzed. Independent risk factors for ARF were the intraoperative lactate level > 6 mmol/l (OR = 4.91; 95% CI 1.26-19.05; p = .02) and cyanotic heart disease (OR = 3.62; 95% CI 1.11-11.63; p = .03).
Conclusions:
This study identified that pediatric patients with lactate levels >6 mmol/l during CPB and those with cyanotic congenital heart disease are a subgroup of high risk to develop ARF after heart surgery and should be closely monitored to prevent, detect and/or treat this complication timely manner.
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