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Factors Associated With Acute Kidney Injury After Cardiopulmonary Bypass in Children
Michael N Gritti1, Pedrom Farid1, Cedric Manlhiot2
1Labatt Family Heart Centre, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Acute kidney injury (AKI) is common after pediatric cardiac surgery. Longer cardiopulmonary bypass (CPB) duration is a key risk factor for AKI, while inflammatory markers are not associated.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) affects approximately 40% of children undergoing cardiopulmonary bypass (CPB).
- Identifying risk factors for AKI in pediatric cardiac surgery is crucial for patient outcomes.
Purpose of the Study:
- To determine risk factors, including inflammatory and vascular endothelial markers, associated with AKI in children undergoing cardiac surgery.
- To investigate the association between perioperative biomarkers and AKI development.
Main Methods:
- Secondary analysis of a prospective observational cohort study.
- AKI defined by serum creatinine increase; biomarkers assessed at 5 perioperative time points.
- Generalized linear regression models used to identify associations with AKI.
Main Results:
- 33% of 207 pediatric patients developed AKI.
- Longer CPB duration and lower preoperative creatinine were independently associated with AKI.
- No significant association found between inflammatory or vascular endothelial biomarkers and AKI.
Conclusions:
- AKI is a prevalent complication following pediatric cardiac surgery.
- Renal ischemia due to prolonged CPB duration is a likely contributor to AKI.
- Investigated inflammatory and vascular endothelial biomarkers were not significantly related to AKI.
Background:
Acute kidney injury (AKI) is a common complication after cardiovascular surgery in children, noted in approximately 40% of children undergoing cardiopulmonary bypass (CPB). We sought to determine the risk factors including inflammatory and vascular endothelial markers associated with AKI in children undergoing cardiac surgery.
Methods:
A secondary analysis of a prospective observational cohort study of paediatric patients with a cardiac defect requiring CPB and a weight of >2.5 kg was performed. AKI was defined as a 1.5 times increase from the preoperative value in serum creatinine or an absolute increase by ≥0.3 mg/dL (≥26.5 μmol/L). Plasma inflammatory markers (interleukin [IL]-1a, IL-1b, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, and tumour necrosis factor α) and vascular endothelial markers (vascular endothelial growth factor, von Willebrand factor, regulated on activation, normal T-cell expressed and secreted, granulocyte macrophage colony-stimulating factor, monocyte chemoattractant protein-1, platelet-derived growth factor, and microparticles) were assessed at 5 perioperative time points. Associations with AKI were found using generalized linear regression models adjusted for repeated measures.
Results:
A total of 207 patients were assessed, of whom 56% (n = 116) were male. Thirty-three percent (n = 68) developed AKI. In univariable analyses, adverse outcomes significantly related to the presence of AKI included increased intensive care unit stay (3.0 vs 5.6 hours, P < 0.001). In multivariable analysis, independent factors that were significantly associated with AKI included longer duration of CPB (111 vs 154 minutes, P < 0.001) and lower preoperative creatinine. Inflammatory and vascular endothelial biomarkers were not associated with AKI.
Conclusions:
AKI remains a prevalent problem after cardiac surgery, and renal ischemia related to longer bypass time potentially plays a key role in the etiology. Inflammatory and vascular endothelial biomarkers were not significantly related to AKI.
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