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Acute Kidney Injury Based on Corrected Serum Creatinine Is Associated With Increased Morbidity in Children Following the Arterial Switch Operation

Basu, Rajit K. MD1,2; Andrews, Anne MD3; Krawczeski, Catherine MD2,4; Manning, Peter MD4; Wheeler, Derek S. MD1,2; Goldstein, Stuart L. MD1,4

Pediatric Critical Care Medicine: June 2013 - Volume 14 - Issue 5 - p e218–e224
doi: 10.1097/PCC.0b013e3182772f61
Online Clinical Investigations

Background and Objectives: Evaluate risk factors for and impact of acute kidney injury on children following the arterial switch operation.

Design: Single-center retrospective chart review.

Setting: A tertiary children’s hospital.

Patients: A total of 92 patients receiving the arterial switch operation from 1997 to 2008 at severe acute kidney injury was defined as a 100% serum creatinine rise over baseline.

Results: Of 92 patients, 18 (20%) developed severe acute kidney injury. Neither patient age or weight nor cardiopulmonary bypass time correlated with the development of acute kidney injury. Acute kidney injury was associated with the following: higher postoperative day 1 (POD1) fluid balance, higher inotrope scores (POD1 and POD2), and longer: postoperative ICU length of stay (p = 0.005), overall ICU length of stay (p = 0.05), and postoperative hospital length of stay (p = 0.006). The time to peak creatinine for acute kidney injury patients was between POD1 and POD2. Correction of serum creatinine for fluid balance increased the population defined as severe acute kidney injury and strengthened the association of acute kidney injury with postoperative morbidity.

Conclusions: Acute kidney injury following the arterial switch operation is associated with increased morbidity. In this single center, single population, and homogenous cohort of patients, the development of acute kidney injury was not correlated with age, size, or cardiopulmonary bypass time, but was still associated with prolonged duration of ventilation and hospitalization. Notably, the failure to correct serum creatinine for fluid balance underestimates the prevalence and impact of acute kidney injury.

1Center for Acute Care Nephrology, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH.

2Department of Pediatrics, Critical Care Medicine, University of Cincinnati, Cincinnati, OH.

3Division of Hospital Medicine, Medical University of South Carolina, Charleston, SC.

4Heart Institute, Cincinnati Children’s Hospital and Medical Center, Cincinnati, OH.

Dr. Krawczeski received grant support from Asklepion Pharmaceuticals and the National Institutes of Health (NIH)/NHLBI and has received support for travel from the NIH/NHLBI. Dr. Manning provided expert testimony at various law firms.The remaining authors have not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies