Related Experiment Video
Updated: Aug 25, 2025
Bilateral Renal Ischemia-Reperfusion Model for Acute Kidney Injury in Mice
Published on: February 2, 2024
The comparison of three different acute kidney injury classification systems after congenital heart surgery
Hatice Dilek Ozcanoglu1, Erkut Öztürk2, İbrahim Cansaran Tanıdır2
1Department of Anaesthesiology and Reanimation, Istanbul Saglik Bilimleri University Basaksehir Cam and Sakura Hospital, Istanbul, Turkey.
Insights
Acute kidney injury (AKI) is common in pediatric heart surgery patients. The Pediatric-Modified Risk, Injury, Failure, Loss, and End-Stage (pRIFLE) system identified more AKI cases, while KDIGO and pRIFLE best predicted mortality.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Cardiac Surgery
Background:
- Acute kidney injury (AKI) is a significant concern in pediatric patients undergoing cardiopulmonary bypass for congenital heart disease.
- Comparing different AKI classification systems is crucial for accurate diagnosis and risk stratification in this vulnerable population.
Purpose of the Study:
- To compare the frequency of AKI using three classification systems: Pediatric-Modified Risk, Injury, Failure, Loss, and End-Stage (pRIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO).
- To evaluate the impact of these classifications on predicting hospital mortality and morbidity in pediatric patients post-congenital heart surgery.
Main Methods:
- A cohort of pediatric patients (<18 years) undergoing congenital heart surgery with cardiopulmonary bypass was studied.
- Postoperative AKI was assessed using pRIFLE, AKIN, and KDIGO criteria.
- Hospital mortality (within 30 days) and morbidity (ICU stay >7 days) were analyzed and compared across the classification systems.
Main Results:
- AKI was diagnosed in 49% (pRIFLE), 31% (AKIN), and 41% (KDIGO) of the 100 included patients.
- Morbidity was observed in 25% of cases, with pRIFLE, AKIN, and KDIGO showing significant predictive value (AUCs: 0.800, 0.747, 0.853, respectively).
- Mortality was 10%, with pRIFLE (AUC: 0.783), AKIN (AUC: 0.717), and KDIGO (AUC: 0.794) also demonstrating significant predictive capabilities.
Conclusions:
- AKI is frequently detected in pediatric patients after congenital heart surgery, irrespective of the classification system used.
- The pRIFLE classification identified a higher proportion of AKI cases compared to AKIN and KDIGO.
- KDIGO and pRIFLE classifications demonstrated superior performance in predicting hospital mortality in this cohort.
Background:
We aimed to compare the frequency of acute kidney injury (AKI) and its effects on mortality and morbidity with different classification systems in pediatric patients who had surgery under cardiopulmonary bypass for congenital heart disease.
Methods:
This study included children younger than 18 years old who were followed up in the pediatric cardiac intensive care unit between September 1 and December 1, 2020, after congenital heart surgery with cardiopulmonary bypass. Each case was categorized postoperatively in terms of AKI using Pediatric-Modified Risk, Injury, Failure, Loss, and End-Stage (pRIFLE), Acute Kidney Injury Network (AKIN), and Kidney Disease: Improving Global Outcomes (KDIGO). Hospital mortality (developed within the first 30 days postoperatively) and morbidity (longer than 7 days intensive care unit stay) were compared by three model classes. Results were evaluated statistically.
Results:
One hundred patients were included in the study. The median age was 3 months (1 day-180 months). Acute kidney injury was diagnosed in 49% of the cases according to the pRIFLE classification. It was diagnosed in 31% of the patients by AKIN classification. It was diagnosed in 41% of the patients with the KDIGO criteria. Morbidity was observed in 25% (n = 25) of all cases. The morbidity predictor was 0.800 for pRIFLE, 0.747 for AKIN and 0.853 for KDIGO by receiver operating characteristics analysis. All three categories predicted morbidity significantly (P < 0.001). Mortality was 10% (n = 10) for all groups. The mortality predictor was 0.783 for pRIFLE, 0.717 for AKIN and 0.794 for KDIGO by receiver operating characteristics analysis, and all three categories predicted mortality significantly (P < 0.001).
Conclusions:
Regardless of the three methods used, AKI was commonly detected in pediatric patients undergoing congenital heart surgery. pRIFLE classification diagnosed more patients with AKI than AKIN and KDIGO. The KDIGO and pRIFLE classifications were better in predicting hospital mortality.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:29Acute Kidney Injury II: Pathophysiology
01:20Acute Kidney Injury V: Interprofessional Care
01:29Acute Kidney Injury III: Clinical Manifestations
01:22Acute Kidney Injury VI: Nursing Management