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Prevention of Acute Kidney Injury in Children Undergoing Cardiac Surgery: A Narrative Review

Esther Huimin Leow1, Yoke Hwee Chan2,3, Yong Hong Ng1

  • 11 Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore.

World Journal for Pediatric & Congenital Heart Surgery
|January 10, 2018
PubMed

Insights

Preventing acute kidney injury (AKI) in children after cardiac surgery is crucial. While avoiding risk factors is key, early peritoneal dialysis shows promise, unlike routine pharmacological methods.

Area of Science:

  • Pediatric Cardiac Surgery
  • Nephrology
  • Critical Care Medicine

Background:

  • Children undergoing cardiac surgery face a significant risk of acute kidney injury (AKI).
  • Cardiac surgery-associated AKI (CS-AKI) is linked to higher mortality and morbidity.
  • Identifying and mitigating modifiable risk factors is essential for CS-AKI prevention.

Purpose of the Study:

  • To review strategies for preventing CS-AKI in pediatric patients.
  • To evaluate the efficacy of pharmacological and non-pharmacological interventions.

Main Methods:

  • Literature review of studies on CS-AKI prevention.
  • Analysis of evidence for pharmacological agents (aminophylline, dexmedetomidine, fenoldopam, steroids).
  • Assessment of non-pharmacological approaches, including early peritoneal dialysis.

Main Results:

  • Modifiable risk factors like maintaining renal perfusion, judicious use of nephrotoxic drugs, and fluid management are vital.
  • Currently, no strong evidence supports routine pharmacological interventions for CS-AKI prevention.
  • Robust evidence supports early peritoneal dialysis as an effective non-pharmacological strategy.

Conclusions:

  • Focusing on modifiable risk factors is paramount in preventing CS-AKI.
  • Pharmacological agents lack strong evidence for routine CS-AKI prevention.
  • Early peritoneal dialysis is a recommended non-pharmacological approach for CS-AKI prevention in pediatric cardiac surgery.

Keywords:
acute kidney injurycardiac surgerycardiopulmonary bypasschildrencongenital heart disease

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