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Risk factors for acute kidney injury after pediatric cardiac surgery: a meta-analysis
Jef Van den Eynde1,2, Boris Delpire3, Xander Jacquemyn3
1Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA. jef.vandeneynde@student.kuleuven.be.
Insights
This meta-analysis identified key clinical risk factors for acute kidney injury (AKI) in pediatric cardiac surgery patients. Understanding these factors can help clinicians anticipate and manage AKI, improving outcomes for this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Cardiac surgery-associated acute kidney injury (AKI) significantly increases morbidity and mortality in pediatric patients.
- Identifying specific risk factors is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To conduct a meta-analysis identifying clinical risk factors for AKI in children undergoing cardiac surgery.
- To provide evidence for developing targeted preventive strategies.
Main Methods:
- A systematic literature search was performed across major databases (PubMed/MEDLINE, Embase, Scopus) up to August 2020.
- Included studies were observational or randomized controlled trials focusing on pediatric cardiac surgery patients with and without AKI.
- Random-effects meta-analysis was used to pool data on various clinical risk factors.
Main Results:
- The pooled incidence of AKI was 34.3% across 61 publications involving 19,680 participants.
- Significant binary risk factors included pulmonary hypertension, cyanotic heart disease, univentricular heart, higher RACHS-1 score, vasopressor use, cardiopulmonary bypass, reoperation, and sepsis.
- Key continuous risk factors comprised younger age, lower body weight, lower preoperative creatinine, higher preoperative eGFR, longer surgical/bypass/cross-clamp times, and greater red blood cell transfusion volume.
Conclusions:
- This meta-analysis successfully identified numerous clinical risk factors associated with AKI in pediatric cardiac surgery.
- These findings can aid clinicians in anticipating, managing, and implementing preventive strategies for CS-AKI.
- Further research may address study heterogeneity and potential residual confounding to refine risk prediction.
Background:
Cardiac surgery-associated acute kidney injury (AKI) is associated with increased morbidity and mortality in both adults and children.
Objectives:
This study aimed to identify clinical risk factors for AKI following cardiac surgery in the pediatric population.
Data Sources:
PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020.
Study Eligibility Criteria:
Studies were included if (1) the population consisted of pediatric patients (< 18 years old), (2) patients underwent cardiac surgery, (3) risk factors were compared between patients who developed AKI and those who did not, and (4) studies were prospective or retrospective observational studies or randomized controlled trials.
Participants And Interventions:
Children undergoing pediatric cardiac surgery.
Study Appraisal And Synthesis Methods:
Random-effects meta-analysis was performed, comparing potential risk factors between pediatric patients who developed CS-AKI and those who did not.
Results:
Sixty-one publications including a total of 19,680 participants (AKI: 7257 participants; no AKI: 12,423 participants) were included from studies published between 2008 and 2020. The pooled estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%, I2 = 96.8%). Binary risk factors that were significantly and consistently associated with AKI were the presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, risk adjustment for congenital heart surgery 1 (RACHS-1) score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis. Significant continuous risk factors included younger age, lower body weight, lower preoperative creatinine, higher preoperative estimated glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery time, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and higher red blood cell transfusion volume.
Limitations:
Results are limited by heterogeneity and potential residual confounding.
Conclusions And Implications Of Key Findings:
Our meta-analysis identified clinical risk factors that are associated with AKI in children undergoing cardiac surgery. This might help clinicians anticipate and manage more carefully this population and implement standardized preventive strategies.
Systematic Review Registration Number:
CRD42021262699. A higher resolution version of the Graphical abstract is available as Supplementary information.
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