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Minimizing Acute Kidney Injury in Pediatric Cardiac Surgery: Incidence, Early Detection, and Preemptive Measures
1Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University), Pune, IND.
Insights
Pediatric cardiac surgery patients experienced a 31.8% incidence of acute kidney injury (AKI). Maintaining hematocrit and using vasopressin reduced AKI risk, while biomarkers like cystatin C and NGAL aided early detection.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is a critical complication in pediatric cardiac surgery, significantly increasing morbidity and mortality.
- Early detection and prevention strategies for AKI in this vulnerable population remain a challenge.
Purpose of the Study:
- To determine the incidence of AKI in pediatric cardiac surgery patients.
- To explore novel biomarkers (cystatin C, NGAL) for early AKI detection.
- To assess risk factors and evaluate preemptive strategies (vasopressin, hematocrit management) to minimize AKI incidence.
Main Methods:
- Prospective observational cohort study of 44 pediatric patients (3 months-15 years) undergoing cardiac surgery.
- Kidney function assessed via serum creatinine, urine output, blood urea, cystatin C, and urine NGAL.
- AKI classification based on AKIN criteria; interventions included low-dose vasopressin and blood transfusion.
Main Results:
- AKI incidence was 31.8% (14/44 patients).
- Elevated serum creatinine, blood urea, cystatin C, and NGAL (>50 ng/ml) were observed in AKI patients.
- Lower intraoperative hematocrit (<30%) strongly correlated with higher AKI incidence (100% vs. 6.2%, p<0.001).
Conclusions:
- Optimizing intraoperative hematocrit levels and preemptive vasopressin use show promise in reducing AKI risk.
- Biomarkers cystatin C and NGAL enable early AKI detection for timely intervention.
- Findings improve risk assessment and perioperative management for pediatric cardiac surgery patients.
Abstract:
Background Acute kidney injury (AKI) poses a significant challenge in pediatric cardiac surgery, having a profound impact on patient morbidity and mortality. This study aims to determine the incidence of AKI, explore novel biomarkers for early detection, assess potential risk factors along with preemptive strategies to minimize its incidence and compare the results with similar studies that did not use these interventions. Methods This prospective observational cohort study, conducted from October 2022 to June 2024 at a tertiary care center, involved 44 pediatric patients, aged three months to 15 years, undergoing cardiac surgery. Kidney function was assessed through preoperative and postoperative measurements of serum creatinine, urine output, blood urea, and newer biomarkers such as cystatin C and urine neutrophil gelatinase-associated lipocalin (NGAL). AKI was defined and classified using the Acute Kidney Injury Network (AKIN) criteria, based on increases in serum creatinine or reductions in urine output within the first three days post surgery. To reduce the risk of AKI, a low-dose vasopressin infusion and blood transfusion were administered to maintain renal perfusion and optimal hematocrit levels. The incidence of AKI was calculated and compared with other studies that did not utilize these strategies Results AKI occurred in 31.8% (n=14) of the pediatric patients undergoing cardiac surgery. To reduce the risk of AKI, preemptive low-dose vasopressin was used as a preventive strategy. Patients who developed AKI exhibited significant elevations in serum creatinine, blood urea, and cystatin C, with postoperative NGAL levels exceeding 50 ng/ml. The study found a strong correlation between lower intraoperative hematocrit levels (<30%) and a higher incidence of AKI (100% vs. 6.2%, p<0.001). Conclusions Effective management of intraoperative hematocrit levels and the preemptive use of vasopressin are promising strategies for reducing AKI risk by optimizing renal perfusion and function during cardiac surgery. Early detection through biomarkers like cystatin C and NGAL offers the potential for timely intervention and better patient outcomes. These findings contribute to improving risk assessment and perioperative management in pediatric patients vulnerable to AKI.
