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Risk Factors and Outcomes of Acute Kidney Injury in Children With Congenital Heart Disease Following Cardiac Surgery

Zaher F Zaher1,2, Mohamed A Shalaby1,3, Khalid A Alhasan4,5

  • 1Pediatric Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.

Saudi Medical Journal
|June 4, 2026
PubMed

Insights

Acute kidney injury (AKI) affects nearly 30% of children undergoing cardiac surgery for congenital heart disease (CHD). Key risk factors include younger age, complex surgery, and longer bypass times, highlighting targets for prevention.

Area of Science:

  • Pediatric Cardiology
  • Nephrology
  • Congenital Heart Disease Research

Background:

  • Acute kidney injury (AKI) is a significant complication in children with congenital heart disease (CHD) undergoing cardiac surgery.
  • AKI is associated with prolonged hospital stays, increased need for kidney replacement therapy, and higher mortality rates in this vulnerable population.

Purpose of the Study:

  • To determine the incidence and identify risk factors for AKI in pediatric patients post-cardiac surgery for CHD.
  • To explore potentially modifiable factors contributing to AKI development in this cohort.

Main Methods:

  • Retrospective analysis of 628 children undergoing cardiac surgery for CHD between 2014-2021.
  • Utilized Kidney Disease Improving Global Outcome (KDIGO) criteria for AKI diagnosis and staging.
  • Compared characteristics of children with and without AKI.

Main Results:

  • 186 (29.6%) children developed AKI.
  • Significant risk factors for AKI included younger age (<1 year), higher Risk Adjustment for Congenital Heart Surgery (RACHS-1) scores, pre-existing renal anomalies, hypoalbuminemia, and cardiac catheterization.
  • Intraoperative factors associated with AKI were longer cardiopulmonary bypass and aortic cross-clamping times, cardiac arrest, ECMO, and respiratory support.
  • Predictive variables for AKI were RACHS-1 score, bypass duration, cardiac catheterization, and renal anomalies.

Conclusions:

  • Identified key preoperative and intraoperative risk factors for AKI in pediatric CHD patients.
  • Findings underscore the importance of addressing these identified factors to mitigate AKI risk and improve outcomes.
  • Highlights the need for targeted interventions in high-risk pediatric cardiac surgery patients.
Abstract

Keywords:
Acute kidney injury (AKI)Cardiac critical care unit (CCCU)Cardiac intensive care unit (CICU)Cardiopulmonary bypassCongenital heart disease (CHD)Kidney replacement therapyPediatricPediatric cardiac surgery

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