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Exploring Racial and Ethnic Disparities in Outcomes Following Pediatric Cardiac Surgery: A NEPHRON Study Analysis.

Jiaxin Huang1, Huaiyu Zang2, Garrett Reichle3

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Summary

Cardiac surgery-associated acute kidney injury (CS-AKI) rates did not differ by race/ethnicity in neonates. While fluid balance achievement varied, no significant disparities were found in mortality or length of stay.

Keywords:
Acute kidney injuryCardiac surgeryDisparitiesKDIGOLength of stayNeonates

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Area of Science:

  • Neonatal critical care
  • Pediatric nephrology
  • Cardiovascular surgery outcomes

Background:

  • Racial and ethnic disparities in neonatal postoperative outcomes are documented.
  • Cardiac surgery-associated acute kidney injury (CS-AKI) disparities in neonates remain unexamined.
  • Congenital heart surgery in neonates presents unique challenges for kidney function.

Purpose of the Study:

  • To assess racial and ethnic disparities in CS-AKI prevalence and outcomes.
  • To investigate differences in CS-AKI among neonates undergoing congenital heart surgery.
  • To identify potential variations in postoperative outcomes based on race/ethnicity.

Main Methods:

  • Retrospective cohort study of 2,165 neonates from 22 centers (2015-2018).
  • Race/ethnicity categorized into eight groups; CS-AKI defined by neonatal modified KDIGO criteria.
  • Outcomes included fluid balance, respiratory support, length of stay, and mortality; multivariable regression analysis used.

Main Results:

  • CS-AKI prevalence (mild 31%, severe 23%) did not differ across racial/ethnic groups.
  • Non-Hispanic Black (NHB) neonates had lower birthweight and higher surgical complexity; Non-Hispanic White (NHW) neonates had higher private insurance.
  • NHB neonates were less likely to achieve net negative fluid balance by POD 3 than NHW neonates; no differences in other outcomes after adjustment.

Conclusions:

  • CS-AKI rates are consistent across racial and ethnic groups in neonates undergoing congenital heart surgery.
  • Fluid balance achievement differences were observed, but not linked to significant disparities in mortality or ventilation duration.
  • This study highlights the importance of monitoring kidney function post-neonatal cardiac surgery without significant racial/ethnic outcome disparities.