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Filtering Down to Risks and Solutions: Risk Factors and Stratification After Pediatric Cardiac Surgery
1Department of Pediatrics, The Heart Institute, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO.
Insights
Acute kidney injury after cardiac surgery (CS-AKI) is a significant concern in pediatric patients, increasing mortality risks. Identifying risk factors and utilizing biomarkers are crucial for better patient stratification and improved outcomes.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury after cardiac surgery (CS-AKI) is a frequent complication in neonates and children undergoing heart procedures.
- CS-AKI is associated with increased mortality and substantial hospital resource utilization.
- Current understanding of CS-AKI risk factors is limited by heterogeneity in study populations, definitions, and practices.
Purpose of the Study:
- To review and summarize identified risk factors for CS-AKI in pediatric populations.
- To discuss the integration of novel biomarkers for early detection and risk stratification.
- To highlight the need for improved risk stratification strategies for future clinical trials.
Main Methods:
- Systematic review of existing literature on CS-AKI risk factors.
- Analysis of identified associations across diverse pediatric cardiac surgery cohorts.
- Evaluation of current diagnostic and prognostic tools, including serum creatinine and biomarkers.
Main Results:
- Consistent risk factors identified across studies include younger age at surgery, prematurity, longer cardiopulmonary bypass times, and surgical complexity.
- Serum creatinine has limitations in early CS-AKI detection and predicting its course.
- CS-AKI exhibits varied severity and duration phenotypes, necessitating tailored management.
Conclusions:
- Improved risk stratification using biomarkers and clinical features is essential for targeted CS-AKI management.
- Future efforts should focus on phenotyping CS-AKI to guide supportive care bundles and clinical decision support.
- Modulating identified risk factors holds potential for mitigating CS-AKI incidence and impact.
Abstract:
Acute kidney injury after cardiac surgery (CS-AKI) is common in neonatal and pediatric populations and is a risk factor for poor outcomes, such as mortality and increased hospital resource utilization. This review presents a summary of CS-AKI risk factors, integration of biomarkers, and the need to improve risk stratification for targeting future clinical trials. To date, studies examining CS-AKI risk factors cannot be generalized easily owing to variability in patient age, surgical complexity or population, AKI definition, and center-specific practices. However, certain risk associations, such as younger age at surgery, history of prematurity, cardiopulmonary bypass time, and surgical complexity, have been identified across multiple, but not all, studies. CS-AKI appears to have different severity and duration phenotypes, and serum creatinine is limited in its ability to identify CS-AKI early and predict CS-AKI course. Treatment strategies are largely supportive, and efforts are ongoing to use biomarkers and clinical features to risk-stratify patients, which in turn may facilitate differential CS-AKI phenotyping and management with supportive care bundles, clinical decision support techniques, and modulation of modifiable risk factors.
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