Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease

2016 ◽  
Vol 27 (6) ◽  
pp. 1068-1075 ◽  
Author(s):  
David M. Kwiatkowski ◽  
Elizabeth Price ◽  
David M. Axelrod ◽  
Anitra W. Romfh ◽  
Brian S. Han ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Kidney Injury ◽  
Congenital Heart Surgery ◽  
Left Ventricular

AbstractBackgroundAcute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.MethodsThis single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.ResultsData from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.ConclusionsWe demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.

scholarly journals Risk Factors for Mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

2017 ◽  
Vol 8 (4) ◽  
pp. 435-439 ◽  
Author(s):  
Carlos A. Villa-Hincapie ◽  
Marisol Carreno-Jaimes ◽  
Carlos E. Obando-Lopez ◽  
Jaime Camacho-Mackenzie ◽  
Juan P. Umaña-Mallarino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Congenital Heart Surgery ◽  
Pediatric Cardiac Surgery ◽  
Cross Clamp Time

Background: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques, and improved perioperative care. Many patients will require reoperation as part of staged procedures or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time; however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. Methods: Historic cohort of patients who underwent reoperation after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. Results: In seven years, 3,086 surgeries were performed, 481 were reoperations, and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross-clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross-clamp time, and Society of Thoracic Surgeons–European Association for Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) Mortality Categories risk category greater than three were risk factors for mortality. The number of resternotomies was not associated with mortality. Mortality prior to hospital discharge was 4.6%, and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative mortality was 5.1%. Conclusions: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.

Independent Risk Factors and 2-Year Outcomes of Acute Kidney Injury after Surgery for Congenital Heart Disease

2017 ◽  
Vol 46 (3) ◽  
pp. 204-209 ◽  
Author(s):  
Daishi Hirano ◽  
Akira Ito ◽  
Akifumi Yamada ◽  
Daisuke Kakegawa ◽  
Saori Miwa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Temporal Trends ◽  
Kidney Injury ◽  
Young Age ◽  
Independent Risk Factors

Background: Data are limited regarding risk factors for acute kidney injury (AKI) following cardiac surgery in children with congenital heart disease (CHD). This observational study was performed to examine temporal trends in AKI incidence according to the Pediatric Risk, Injury, Failure, Loss, End-Stage Renal Disease (pRIFLE) criteria, identify independent risk factors for AKI after cardiac surgery, and examine associations between AKI and long-term mortality. Methods: We retrospectively evaluated 418 patients (259 males, 159 females; median age, 5 months) who underwent cardiac surgery for CHD between April 2007 and August 2013. Patients were followed up for 2 years. AKI was defined according to the pRIFLE criteria as ≥25% decrease in estimated creatinine clearance. Results: AKI developed postoperatively in 104 cases (24.9%). Approximately 80% belonged to the “Risk” category according to the pRIFLE criteria, and only 21 cases (5%) required renal replacement therapy (peritoneal dialysis in all cases). Multivariate analysis revealed 3 independent risk factors for onset of AKI: young age (<1 year), surgery in Risk Adjustment in Congenital Heart Surgery (RACHS-1) category ≥4, and long cardiopulmonary bypass (CPB) time (≥90 min). Twenty-three patients (22%) with AKI died during the 2-year follow-up. In multivariate cox hazard regression analysis, the most significant contributor to risk of mortality was AKI. Conclusions: Postoperative AKI was strongly associated with young age, high RACHS-1 category, and prolonged CPB time. In addition, mortality rate was higher in patients who survived after recovery from AKI than in those without AKI, even among the lower pRIFLE categories.

Preoperative Albumin Level is not Associated with Acute Kidney Injury After Pediatric Cardiac Surgery: A Retrospective Cohort

2021 ◽  
Author(s):  
Fatma Ukil Isildak ◽  
Yasemin Yavuz ◽  
Omer Faruk Savluk ◽  
Nihat Cine ◽  
Ufuk Uslu
Keyword(s):  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Retrospective Cohort ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Preoperative Albumin

Objectives: This study aimed to evaluate whether the development of acute kidney injury (AKI) was associated with preoperative albumin/prealbumin levels and other clinical features in pediatric patients who underwent open-heart surgery for congenital heart disease. Patients and Methods: In this retrospective cohort, patients aged between 1 – 60 months who underwent open-heart surgery (complete correction surgery) with a diagnosis of congenital heart disease at the XXXXXX, between January 1, 2018 - December 31, 2020, were retrospectively included (n = 100). Patient demographics, diagnoses, surgical characteristics, and laboratory findings were recorded and analyzed. Results: Mean age was 13.63 ± 12.05 (range 1.5 - 60) months. eGFR was decreased by more than 50% in 13% of the cases. Compared to the preoperative period, it was found that urea (24th and 48th hour) and creatinine levels increased significantly (p< 0.001, for each), and eGFR decreased significantly in the postoperative period (p< 0.001). Linear regression for eGFR value revealed that longer aortic cross-clamp time (ACCT) was associated with a greater decrease in eGFR (p= 0.046). Other variables included in the model, age (p= 0.128), gender (p= 0.358), RACHS (p= 0.865), body mass index (p= 0.862), prealbumin (p= 0.313), albumin (p= 0.806) and duration of cardiopulmonary bypass (p= 0.921) were found to be non-significant. Conclusion: While there was no relationship between eGFR and preoperative albumin/prealbumin levels in patients who underwent cardiac surgery due to congenital heart disease, longer ACCT was found to be associated with decreased eGFR.

scholarly journals Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease

2017 ◽  
Vol 92 (3) ◽  
pp. 751-756 ◽  
Author(s):  
Nicolas L. Madsen ◽  
Stuart L. Goldstein ◽  
Trine Frøslev ◽  
Christian F. Christiansen ◽  
Morten Olsen
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Kidney Disease ◽  
Congenital Heart ◽  
Kidney Injury

Characteristics and outcomes of children with congenital heart disease needing diaphragm plication

2019 ◽  
Vol 30 (1) ◽  
pp. 62-65 ◽  
Author(s):  
Cortney B. Foster ◽  
Antonio G. Cabrera ◽  
Dayanand Bagdure ◽  
William Blackwelder ◽  
Brady S Moffett ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Length Of Stay ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Congenital Heart Surgery ◽  
Hospital Length Of Stay ◽  
P Value ◽  
Diaphragm Dysfunction

AbstractBackground:Diaphragm dysfunction following surgery for congenital heart disease is a known complication leading to delays in recovery and increased post-operative morbidity and mortality. We aimed to determine the incidence of and risk factors associated with diaphragm plication in children undergoing cardiac surgery and evaluate timing to repair and effects on hospital cost and length of stay.Methods:We conducted a multi-institutional retrospective observational cohort study. Forty-three hospitals from the Pediatric Health Information System database were included, and a total of 112,110 patients admitted between January 2004 and December 2014 were analysed.Results:Patients less than 18 years of age who underwent cardiac surgery were included. Risk Adjustment for Congenital Heart Surgery was utilized to determine procedure complexity. The overall incidence of diaphragm dysfunction was 2.2% (n = 2513 out of 112,110). Of these, 24.0% (603 patients) underwent diaphragm plication. Higher complexity cardiac surgery (Risk Adjustment for Congenital Heart Surgery 5–6) and age less than 4 weeks were associated with a higher likelihood of diaphragm plication (p-value < 0.01). Diaphragmatic plication was associated with increased hospital length of stay (p-value < 0.01) and increased medical cost.Conclusions:Diaphragm plication after surgery for congenital heart disease is associated with longer hospital length of stay and increased cost. There is a strong correlation of prolonged time to plication with increased length of stay and medical cost. The likelihood of plication increases with younger age and higher procedure complexity. Methods to improve early recognition and treatment of diaphragm dysfunction should be developed.

Risk Factors and Primary Diseases Responsible for Acute Kidney Injury among Neonates

2021 ◽  
Vol 8 (1) ◽  
pp. 12-16
Author(s):  
Sharmin Akter Luna ◽  
Syma Akter ◽  
Tahmina Jesmin ◽  
Syed Saimul Haque ◽  
Golam Muin Uddin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Age Group ◽  
Cross Sectional ◽  
One Year

Background: There are several risk factors and diseases related with the acute kidney injury among neonates. Objective: The purpose of the present study was to find out the risk factors and primary disease responsible for acute kidney injury among neonates. Methodology: This cross-sectional study was conducted in the Department of Paediatric Nephrology at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh from May 2018 to July 2019 for a period of one year. Patients with the age group of less than 1 months who were at risk of AKI, and admitted in the inpatient department of Pediatrics and allied at Bangabandhu Sheikh Mujib University, Dhaka, Bangladesh in both sexes were selected as study population. To detect AKI, serum creatinine was measured at 0 h (baseline), 48 h and 5th day respectively. Result: A total number of 52 patients who fulfilled the inclusion criteria were enrolled in this study. Among them 10 cases were in neonatal age group. The mean age was 10.8±5.4 days with female predominance. The risk factors of AKI in neonate was only pre-renal; mostly due to hypovolemia which was 3(60.0%) cases followed by sepsis and asphyxia which were 1(20.0%) case in each. The most patients had sepsis which was 4(40.0%) cases followed by congenital heart disease which was 2(20.0%) cases; one presented with heart failure and another one had cyanotic congenital heart disease. Conclusion: In conclusion hypovolemia, sepsis and asphyxia are the most common risk factors of acute kidney injury among the neonates. Journal of Current and Advance Medical Research, January 2021;8(1):12-16

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