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Risks of acute renal failure after cardiopulmonary bypass surgery in children: a retrospective 10-year case-control
S Picca1, F Principato, E Mazzera
1Department of Nephrology and Dialysis, Bambino Gesù Children Research Hospital, Rome, Italy.
Insights
Identifying acute renal failure (ARF) risk factors after cardiopulmonary bypass in children is crucial. Prolonged central venous hypertension and hypotension are significant predictors of ARF in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Acute renal failure (ARF) is a serious complication following cardiopulmonary bypass (CPB) surgery in children.
- Limited research exists on specific risk factors for ARF post-CPB in pediatric populations.
Purpose of the Study:
- To identify and evaluate the primary risk factors associated with the development of ARF after CPB surgery in children.
- To inform clinical practice and improve outcomes for pediatric patients undergoing CPB.
Main Methods:
- A retrospective case-control study was conducted involving 2262 children who underwent CPB surgery.
- Sixty-one children who developed ARF requiring peritoneal dialysis were matched with 176 controls based on age, CPB duration, circulatory arrest duration, and year of operation.
- Multiple regression analysis was used to determine significant risk factors.
Main Results:
- The incidence of ARF post-CPB was 2.7%, with a high mortality rate of 79% in affected children.
- Significant risk factors for ARF included central venous hypertension > 12 hours (OR 9.6), systolic arterial hypotension > 12 hours (OR 8.9), dopamine use > 15 µg/kg/min (OR 3.0), adrenaline use (OR 5.9), and isoproterenol use (OR 13.5).
- High preoperative serum creatinine, cyanosis, and vasodilator use were not found to be significant risk factors.
Conclusions:
- Prolonged central venous hypertension and systolic arterial hypotension are major risk factors for ARF following CPB in children.
- Specific vasoactive agent use (dopamine, adrenaline, isoproterenol) is also significantly associated with ARF development.
- These findings highlight the need for vigilant hemodynamic monitoring and management during and after CPB surgery in pediatric patients to mitigate ARF risk.
Abstract:
To our knowledge there are no case-control studies that have examined the main risk factors for acute renal failure (ARF) following cardiopulmonary bypass surgery in children. We therefore evaluated the potential risk factors in a large retrospective case-control study. Sixty-one of 2262 children (2.7%) developed postcardiopulmonary bypass surgery ARF requiring peritoneal dialysis (PD) from 1982 to 1991. Fifty-eight of 61 cases (median age 8.5 months) were selected by systematic sampling and matched with 176 controls who did not develop ARF. The four matching variables were age, cardiopulmonary bypass and circulatory arrest duration, and year of operation. Mortality rate was 79% in cases (controls: 18%). Forty-three of 48 of the deceased cases did not recover renal function: no renal cause of death was found; 13 of 61 cases survived and recovered renal function. Multiple regression analysis showed the following significant risk factors for postcardiopulmonary bypass surgery ARF: central venous hypertension > 12 h (odds ratio (OR) 9.6); systolic arterial hypotension > 12 h (OR 8.9); dopamine dosage > 15 micrograms/kg/min (OR 3.0); adrenaline (OR 5.9) and isoproterenol (OR 13.5) use. High preoperative serum creatinine, cyanosis, and vasodilator use were not significant risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)