scholarly journals Acute kidney injury after cardiac surgery in children

2021 ◽  
Vol 25 (4) ◽  
pp. 11
Author(s):  
S. A. Sergeev ◽  
V. V. Lomivorotov
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Conflict Of Interest ◽  
Kidney Injury ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Paediatric Cardiac Surgery ◽  
Severe Stage ◽  
Prevention And Treatment

<p>Acute kidney injury (AKI) after cardiac surgery in children remains a common clinical concern. The approaches developed recently and applied in clinical practice have sufficiently helped in clarifying the epidemiology, risk factors and pathophysiology of AKI in paediatric cardiac surgery. Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease criteria (pRIFLE), Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO), which are based on changes in serum creatinine levels and urine output rate, enable the identification and ranking of AKI according to severity. However, the diagnostic strategies for AKI have developed beyond creatinine levels and recommend the use of markers of renal tissue damage. Currently, two markers, neutrophil gelatinase-associated lipocalin and TIMP-2/IGFBP-7 (tissue inhibitor of metalloproteinase 2 and protein that binds insulin-like growth factor-7), can be used for the early diagnosis of AKI in paediatric cardiac surgery.<br />Various risk factors, both renal and extrarenal, can predict AKI after cardiac surgery, among which age, the duration of cardiopulmonary bypass and the need for mechanical ventilation and inotropic support before surgery, are the most significant. Strategies for addressing modifiable risk factors (maintaining appropriate perfusion pressure during cardiopulmonary bypass and avoiding nephrotoxic drugs and fluid overload) will reduce the risk of developing AKI. There has been a significant increase in survival rates due to the introduction of ultrafiltration techniques and the early initiation of renal replacement therapy in the postoperative period.<br />The purpose of this review is to analyse the current literature data on AKI in paediatric cardiac surgery. The review results demonstrate the differences in the incidence of AKI associated with cardiac surgery and the effectiveness of certain methods for prevention and treatment of this complication. Further comprehensive research on the issue of AKI in children, creation of medical electronic databases on patients, minimisation of the influence of possible risk factors and timely prevention and treatment of complications would prevent the development of AKI and reduce the possibility of complication progression to a more severe stage.</p><p>Received 12 April 2021. Revised 24 June 2021. Accepted 25 June 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest: </strong>Authors declare no conflict of interest.</p><p><strong>Contribution of the authors:</strong> The authors contributed equally to this article.</p>

Acute Kidney Injury in Children Undergoing Correction of Congenital Heart Disease

2011 ◽  
Vol 140 ◽  
pp. 84-90
Author(s):  
Yu Qing Jiao ◽  
Geng Xu Zhou ◽  
Jian Ping Huang ◽  
Xiao Yang Hong ◽  
Xue Yong Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Cell ◽  
Cardiac Disease ◽  
Kidney Injury ◽  
Red Blood Cell Transfusion ◽  
Congenital Cardiac Disease

Objective To assess risk factors of acute kidney injury in congenital cardiac disease following cardiac surgery with cardiopulmonary bypass in children. Methods A 50% postoperative creatinine increase was regarded as the criterion of acute kidney injury. 124 children aged 3 years or little undergoing cardiac surgery were divided into three groups: (1) negative AKI (-); (2) AKI (+) with an increase in postoperative creatinine from 150% to 200%; and (3) AKI (++) with an increase in postoperative creatinine by more than 200%. Demographics, and preoperative, intraoperative, and postoperative variables were evaluated for associations with AKI using univariate and multiple logistic regression analysis. Results Several variables, including mortality, preoperative albumin and creatinine levels, cardiopulmonary bypass duration, and postoperative creatinine levels, were significant differences among the three groups (P < 0.05). Multiple regression analysis demonstrated that three risk factors, age (OR, 0.962; 95% CI, 0.925 to 1.000; P = 0.046), intraoperative red blood cell transfusion (OR, 1.003; 95% CI, 1.001 to 1.005; P = 0.030), and cardiopulmonary bypass duration (OR, 1.024; 95% CI, 1.016 to 1.032; P = 0.000) were independently associated with AKI after cardiac surgery. Conclusions This study showed that younger age, incremental intraoperative red blood cell transfusion, and prolonged cardiopulmonary bypass duration were independently associated with acute kidney injury after cardiac surgery. The type of congenital cardiac disease should be included in the analysis of acute kidney injury.

scholarly journals The Albumin-to-Fibrinogen Ratio Independently Predicts Acute Kidney Injury in Infants With Ventricular Septal Defect Undergoing Cardiac Surgery With Cardiopulmonary Bypass

2021 ◽  
Vol 9 ◽  
Author(s):  
Fan Cao ◽  
Xinxin Chen ◽  
Guodong Huang ◽  
Wenhua Liu ◽  
Na Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Cardiopulmonary Bypass ◽  
Ventricular Septal Defect ◽  
Independent Risk Factor ◽  
Septal Defect ◽  
Kidney Injury ◽  
Elective Cardiac Surgery

Background: Acute kidney injury (AKI) is a common and serious complication faced by children following ventricular septal defect (VSD) surgery with cardiopulmonary bypass (CPB). The objective of this study was to explore potential predictors inherent to AKI.Methods: VSD infants who were scheduled for elective cardiac surgery with CPB from 2017 to 2020 were enrolled in this study. Based on the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, patients were divided into AKI and non-AKI groups. Univariate and multivariate logistic regression analyses were carried out in order to evaluate potential risk factors for AKI. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive probabilities of risk factors for AKI.Results: Of all the 338 enrolled VSD infants, 49 manifested AKI with an incidence of 14.5% (49/338). The ROC curve indicated that albumin-to-fibrinogen ratio (AFR) during CPB was a significant predictor of AKI [area under the curve (AUC), 0.711; p &lt; 0.001]. Based on the univariate and multivariate logistic analyses, AFR during CPB [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.22–2.76, p = 0.011] was the only independent risk factor for AKI.Conclusions: This study demonstrated that a low AFR (&lt;9.35) during CPB was an independent risk factor for AKI in VSD infants following cardiac surgery with CPB.

scholarly journals Acute kidney injury in cardiac surgery: preoperative predictive diagnostics

2021 ◽  
Vol 25 (1) ◽  
pp. 40
Author(s):  
N. O. Kamenshchikov ◽  
Yu. K. Podoksenov ◽  
M. L. Diakova ◽  
A. M. Boyko ◽  
B. N. Kozlov
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Clinical Practice ◽  
High Risk ◽  
Conflict Of Interest ◽  
Kidney Injury ◽  
Perioperative Period ◽  
Predictive Diagnostics ◽  
Predictive Diagnosis

<p>Acute kidney injury (AKI) and its delayed diagnosis often lead to an increase in the number of patients with chronic kidney disease. There is no denying the importance of studying the pathogenetic mechanisms of AKI, timely predictive identification of patients at high risk of CSA-AKI, as well as the need to search for and improve perioperative strategies to prevent CSA-AKI. The development of new approaches regarding predictive diagnostics of AKI and their widespread introduction into a wide clinical practice will improve the prognosis and survival of these patients.<br />The modern diagnostic continuum of AKI considers risk factors as pre-existing conditions against which adverse factors of the perioperative period are realised. Risk factors for AKI in cardiac surgery are divided into two categories: 1) patient-dependent and 2) operations-associated or modifiable risk factors for the development of AKI, to some extent secondary to iatrogenic effects (adverse factors of the perioperative period). A clear understanding of the significance of these factors regarding the development of AKI in cardiac surgery patients allows us to form risk scales for predicting CSA-AKI in the postoperative period. This review presents the following work, which is a milestone for the predictive diagnosis of AKI in cardiac surgery: model Association of Nephrology and the Association of Anaesthesiologists and Reanimatologists of Russia, the scale EuroSCORE II, the STS Score, Score Mehta, ‘risk index perioperative renal dysfunction/failure’, S. Aronson et al., scale S.Y. Ng et al., model K. Birnie et al.<br />The use of predictive models for the predictive diagnosis of CSA-AKI is an important strategy for identifying high-risk patients. This approach allows active application of preventive strategies regarding AKI in routine clinical practice. It also has distinct advantages regarding conducting cohort clinical studies of new renoprotective technologies. To date, there is no ‘gold standard’ scale for predicting the risk of cardiac AKI. The authors propose consideration of their application as a weighted ‘Solomon’ solution, according to a specific clinical situation.</p><p>Received 10 July 2020. Revised 9 September 2020. Accepted 10 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova<br />Drafting the article: N.O. Kamenshchikov, M.L. Diakova, A.M. Boyko<br />Critical revision of the article: M.L. Diakova, Yu.K. Podoksenov<br />Final approval of the version to be published: N.O. Kamenshchikov, Yu.K. Podoksenov, M.L. Diakova, A.M. Boyko, B.N. Kozlov</p>

scholarly journals Risk factors for acute kidney injury in postoperative cardiac surgery

2021 ◽  
Vol 10 (2) ◽  
pp. e34710212480
Author(s):  
Mario Augusto Cray da Costa ◽  
Stella Kuchller ◽  
Vanessa Carolina Botta ◽  
Adriana de Fátima Menegat Schuinski ◽  
Ana Carolina Mello Fontoura de Souza
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Body Mass ◽  
Kidney Injury ◽  
Male Gender ◽  
Baseline Serum ◽  
Significant Difference

Objective: To evaluate the perioperative risk factors associated with postoperative AKI in patients undergoing cardiac surgery. Methodology: Between January 2011 and December 2017, we analyzed prospectively 544 patients, who were divided into two groups: patients with acute kidney injury associated with cardiac surgery (AKI-ACS) defined as an increase of 0.3 mg/dL or 1.5 times the baseline serum creatinine value and control group formed by patients without AKI-ACS. We compared patients and surgical variables using the chi-square test, Fisher's exact test, and mann-Whitney test and logistic regression. Results: AKI-ACS occurred in 29.8% of the patients. In the univariate analysis, the following variables presented a statistically significant difference: male gender (p=0.0087), age (p<0.0001), body mass (p=0.035), BMI (p=0.001), thoracic aortic surgery (p=0.029), use of extracorporeal circulation (p=0.012), CPB time (p=0.0001), aortic clamping time (p=0.0029), use of vasoactive drugs in post-operative  period (p=0.017), preoperative kidney function (p<0.0001), presence of diabetes mellitus (p=0.008) and NYHA functional class (p=0.041). In the multivariate analysis, the following variables presented a statistical difference: male gender (OR 2.11), higher BMI (OR 2.11), worse preoperative renal function, demonstrated by creatinine clearance (OR 0.13), longer cardiopulmonary bypass (OR 1.008). Conclusion: The independent predictors for LRA-ACC were male gender, higher body mass index, worse preoperative renal function, and more complex surgeries associated with longer cardiopulmonary bypass.

scholarly journals Association of Preoperative Diuretic Use With Early Acute Kidney Injury in Infants With Biventricular Hearts Following Cardiac Surgery

2021 ◽  
Author(s):  
Steven L. Rathgeber ◽  
Adrija Chakrabarti ◽  
Eva Kapravelou ◽  
Nicole Hemphill ◽  
Christine Voss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Cardiopulmonary Bypass ◽  
Tetralogy Of Fallot ◽  
Odds Ratio ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Stage 1

Background Diuretics are used to manage congestive heart failure in infants with congenital heart disease. Adult data indicate that preoperative diuretic use increases the risk of cardiac surgery associated acute kidney injury (CS‐AKI). We have sought to understand if preoperative diuretics in infants increases the risk of CS‐AKI. Methods and Results This is a single‐center retrospective study of infants (1–12 months) who had CS requiring cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS‐AKI was defined according to the Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2–12.9 months). A total of 149 (49.7%) patients were diagnosed with CS‐AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative diuretics were not associated with CS‐AKI (odds ratio [OR], 0.79; 95% CI, 0.43–1.44; P =0.45). A diagnosis of tetralogy of Fallot was an independent risk factor for CS‐AKI (OR, 3.49; 95% CI, 1.33–9.1, P =0.01). A diagnosis of tetralogy of Fallot (OR, 3.6; 95% CI, 1.28–10.22; P =0.02) and longer cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0–1.02; P =0.04) time are risk factors for moderate to severe CS‐AKI. Conclusions Preoperative diuretic use does not contribute to the risk of CS‐AKI in infants early after surgery. A diagnosis of tetralogy of Fallot was the only risk factor for CS‐AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of tetralogy of Fallot and longer cardiopulmonary bypass time are risk factors for moderate to severe CS‐AKI.

scholarly journals Perioperative risk factors for delirium development after elective cardiovascular surgery

2020 ◽  
Vol 24 (2) ◽  
pp. 83
Author(s):  
V. V. Pasyuga ◽  
D. A. Demin ◽  
I. L. Nudel ◽  
E. V. Demina ◽  
A. V. Kadykova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Conflict Of Interest ◽  
Kidney Injury ◽  
Perioperative Risk ◽  
Perioperative Risk Factors

<p><strong>Aim.</strong> This study was conducted to determine the incidence of delirium after cardiac surgery and its effect on the length of the patient’s stay in the ICU and to identify the perioperative risk factors.<br /><strong>Methods.</strong> This research was a retrospective assessment of 1941 medical records and the course of the perioperative period in patients subjected to elective cardiac surgery.<br /><strong>Results.</strong> Delirium developed in 193 cases (9.94%); whereas, hyperactive, hypoactive and mixed delirium was observed in 13%, 43% and 44% of the patients, respectively. Most often (26% of the cases), delirium occurred after complex combined surgeries. Independent risk factors for the development of delirium were older age (OR 1.041, 95% CI [1.002–1.081], p = 0.038), EuroSCORE II score (OR 1.286, 95% CI [1.093–1.731], p = 0.025), acute kidney injury (OR 1.306, 95% CI [1.107–1.942], p = 0.0018) and renal replacement therapy (OR 1.399 95% CI [1.361–2.792], p = 0.001). Cardiopulmonary bypass duration and time of clamping of the aorta, postoperative serum creatinine level, need for blood transfusions and duration of mechanical ventilation and duration of ICU stay were identified as predictors and were also significantly higher in the delirium group. Delirium was closely associated with critical illness polyneuropathy (OR 9.201, 95% CI [2.13–38.826], p &lt; 0.001) and neurogenic dysphagia (OR 7.48, 95% CI [1.12–56.07], p = 0.022).<br /><strong>Conclusion.</strong> The key factors for delirium development in the postoperative period include advanced age, high EuroSCORE II scale and acute kidney injury requiring continuous renal replacement therapy. Delirium significantly increases the duration of mechanical ventilation and the duration of ICU stay.</p><p>Received 30 January 2020. Revised 18 March 2020. Accepted 24 March 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and design: V.V. Pasyuga, I.N. Leiderman<br />Data collection: D.A. Demin, E.V. Demina, I.L. Nudel, V.V. Pasyuga <br />Data analysis: V.V. Pasyuga, I.N. Leiderman, D.A. Demin, D.G. Tarasov<br />Drafting the article: V.V. Pasyuga, D.A. Demin<br />Critical revision of the article: I.N. Leiderman, A.V. Kadykova<br />Final approval of the version to be published: V.V. Pasyuga, D.A. Demin, I.L. Nudel, E.V. Demina, A.V. Kadykova, D.G. Tarasov, I.N. Leiderman</p>

Acute kidney injury in children after cardiopulmonary bypass: Risk factors and outcome

2015 ◽  
Vol 52 (3) ◽  
pp. 223-226 ◽  
Author(s):  
Sidharth Kumar Sethi ◽  
Maneesh Kumar ◽  
Rajesh Sharma ◽  
Subeeta Bazaz ◽  
Vijay Kher
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Kidney Injury

scholarly journals Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: A prospective multicenter study*

2011 ◽  
Vol 39 (6) ◽  
pp. 1493-1499 ◽  
Author(s):  
Simon Li ◽  
Catherine D. Krawczeski ◽  
Michael Zappitelli ◽  
Prasad Devarajan ◽  
Heather Thiessen-Philbrook ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Multicenter Study ◽  
Kidney Injury ◽  
Pediatric Cardiac Surgery ◽  
Prospective Multicenter Study ◽  
Incidence Risk
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