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Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Hasson, Denise C. MD1; Brinton, John T. PhD2; Cowherd, Ellen BA3; Soranno, Danielle E. MD4; Gist, Katja M. DO, MSc5

Pediatric Critical Care Medicine: July 2019 - Volume 20 - Issue 7 - p 614-620
doi: 10.1097/PCC.0000000000001939
Cardiac Intensive Care

Objectives: Determine the risk factors for repeated episodes of acute kidney injury in children who undergo multiple cardiac surgical procedures.

Design: Single-center retrospective chart review.

Setting: Cardiac ICU at a quaternary pediatric care center.

Patients: Birth to 18 years who underwent at least two cardiac surgical procedures with cardiopulmonary bypass.

Interventions: None.

Measurements and Main Results: One-hundred eighty patients underwent two cardiac surgical procedures and 89 underwent three. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Acute kidney injury frequency was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most acute kidney injury occurring on postoperative days 1 and 2. The proportion of patients with severe acute kidney injury increased from surgery 1 to surgery 3. Patients with acute kidney injury had a significantly longer duration of ventilation and length of stay after each surgery. The odds of acute kidney injury after surgery 3 was 2.40 times greater if acute kidney injury was present after surgery 1 or 2 (95% CI, 1.26–4.56; p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with acute kidney injury (p = 0.85).

Conclusions: In a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of acute kidney injury after a third surgery was increased by the presence of acute kidney injury after prior procedures. Time between surgery did not play a role in increasing odds of acute kidney injury. Further studies in a larger multicenter investigation are necessary to confirm these findings.

1Department of Graduate Medical Education, University of Colorado Anschutz Medical Campus, Aurora, CO.

2Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO.

3Children’s Hospital Colorado Summer Internship Program, The Heart Institute, Aurora, CO.

4Division of Pediatric Nephrology, Department of Pediatrics, Medicine and Bioengineering, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO.

5Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO.

This was presented as an abstract, in part, at the Pediatric Academic Society Meeting in Toronto, ON, Canada (May 7, 2018).

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Dr. Brinton disclosed that a portion of his time is supported by the Children’s Hospital Colorado Research Institute and Pediatric Kidney Injury and Disease Stewardship Program to help with analyses and manuscript preparation. Dr. Soranno’s institution received funding from the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Gist received support for article research from the NIH (Loan repayment program). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies