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 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 < 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 (<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 renal transplant recipients undergoing cardiac surgery

2020 ◽  
Vol 36 (1) ◽  
pp. 185-196
Author(s):  
Gregory L Hundemer ◽  
Anand Srivastava ◽  
Kirolos A Jacob ◽  
Neeraja Krishnasamudram ◽  
Salman Ahmed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Renal Transplant ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Trough Levels

Abstract Background Acute kidney injury (AKI) is a key risk factor for chronic kidney disease in the general population, but has not been investigated in detail among renal transplant recipients (RTRs). We investigated the incidence, severity and risk factors for AKI following cardiac surgery among RTRs compared with non-RTRs with otherwise similar clinical characteristics. Methods We conducted a retrospective cohort study of RTRs (n = 83) and non-RTRs (n = 83) who underwent cardiac surgery at two major academic medical centers. Non-RTRs were matched 1:1 to RTRs by age, preoperative (preop) estimated glomerular filtration rate and type of cardiac surgery. We defined AKI according to Kidney Disease: Improving Global Outcomes criteria. Results RTRs had a higher rate of AKI following cardiac surgery compared with non-RTRs [46% versus 28%; adjusted odds ratio 2.77 (95% confidence interval 1.36–5.64)]. Among RTRs, deceased donor (DD) versus living donor (LD) status, as well as higher versus lower preop calcineurin inhibitor (CNI) trough levels, were associated with higher rates of AKI (57% versus 33% among DD-RTRs versus LD-RTRs; P = 0.047; 73% versus 36% among RTRs with higher versus lower CNI trough levels, P = 0.02). The combination of both risk factors (DD status and higher CNI trough level) had an additive effect (88% AKI incidence among patients with both risk factors versus 25% incidence among RTRs with neither risk factor, P = 0.004). Conclusions RTRs have a higher risk of AKI following cardiac surgery compared with non-RTRs with otherwise similar characteristics. Among RTRs, DD-RTRs and those with higher preop CNI trough levels are at the highest risk.

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.

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 P0115EFFECT OF CARDIOPULMONARY BYPASS ON THE DEVELOPMENT OF ACUTE KIDNEY INJURY AFTER OPEN-HEARD SURGERY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nikolai Molchan ◽  
Regina Akmalova ◽  
Dmitriy Sokolov ◽  
Olga Galkina ◽  
Yuri Polushin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
General Anesthesia ◽  
Postoperative Period ◽  
Kidney Injury ◽  
Open Heart ◽  
Acute Renal Dysfunction ◽  
Stage 1 ◽  
Nonparametric Correlation

Abstract Background and Aims Assessment of factors associated with cardiopulmonary bypass (CPB) in acute renal dysfunction in patients in the early postoperative period after cardiac surgery. Method Monocentric observational study in patients (n = 97) who underwent elective open-heart cardiac surgery (coronary artery bypass grafting -50.44%, aortic valve prosthetics - 31.04%, mitral valve prosthetics - 12.61%) using cardiopulmonary bypass. Inclusion criteria: the study included patients not younger than 18 years old, undergoing cardiac surgery with CPB lasting up to 95 minutes (coronary bypass surgery, valve replacement), without signs of end-stage chronic kidney disease (CKD). Using nonparametric correlation analysis, we evaluated the effect on the development of acute kidney injury (AKI) of the following extracorporeal circulation factors: duration of CPB, aortic cross-clamp, mean arterial pressure (MAP), cardiac index (CI), perfusion flow rate (PFR), transport, consumption and oxygen extraction variables. The diagnosis of AKI was made on the basis of the KDIGO classification, the studied parameters were recorded initially (before the operation), 15 minutes after the start of general anesthesia, 30 minutes after the start of cardiopulmonary bypass and 15 minutes after the end of general anesthesia. Results The frequency of AKI in 24 hours after surgery was 56.3% (58 cases): including stage 1 in 37 (35.9%), stage 2 in 17 (16.5%), stage 3 - in 4 (3.9%) patients. In the 48th hour of the postoperative period signs of AKI regressed, and were presented in only 26 people (25.2%), including the stage 1 in 18 (17.5%), the stage 2 - in 5 (4.8%), stage 3 - in 3 (2.9%). Among the risk factors for AKI in cardiac surgery with CPB, the main effect of of the anemia was revealed, especially a decrease in hemoglobin levels of less than 90 g / l and hematocrit of less than 25%. Conclusion Hemodilution below the "threshold" values of hemoglobin and hematocrit during the CPB provoke acute kidney injury in patients undergoing open-heart surgery.

scholarly journals Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jack S Bell ◽  
Benjamin D James ◽  
Saif Al-Chalabi ◽  
Lynne Sykes ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Hospital Acquired

Abstract Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

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>

Haematocrit differences modify the association of cardiopulmonary bypass reoxygenation with acute kidney injury after paediatric Tetralogy of Fallot repair

Perfusion ◽  
2019 ◽  
Vol 35 (4) ◽  
pp. 284-289 ◽  
Author(s):  
Hong Liu ◽  
Si-qiang Zheng ◽  
Si-chong Qian ◽  
Huang-he He ◽  
Jin-rong Xue
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Confidence Interval ◽  
Tetralogy Of Fallot ◽  
Odds Ratio ◽  
Injury Risk ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Specific Reference ◽  
Tetralogy Of Fallot Repair

Background: Little is known regarding the potential impact of haematocrit differences in the association between cardiopulmonary bypass reoxygenation and acute kidney injury following Tetralogy of Fallot repair. Methods: We investigated the association of perfusate oxygenation during aortic occlusion associated with acute kidney injury between 204 normal and 248 higher haematocrit children with Tetralogy of Fallot, aged 1 month-18 years, who were surgically repaired in 2012-2018. Normal and higher haematocrit children were defined as having a preoperative haematocrit within and above age- and sex-specific reference intervals, respectively. Acute kidney injury was determined as a binary variable according to the Kidney Disease Improving Global Outcomes criteria. Results: After adjusting for baseline and clinical covariates, a significant interaction between the haematocrit and continuous perfusate oxygenation on acute kidney injury was found (pinteraction = 0.049): a higher perfusate oxygenation was associated with a greater acute kidney injury risk among higher haematocrit children (adjusted odds ratio = 1.50, 95% confidence interval = [1.02, 2.22] per SD, p = 0.038) but not among normal haematocrit children (adjusted odds ratio = 0.91, 95% confidence interval = [0.51, 1.63] per SD, p = 0.73). After a similar adjustment, there was a marginal interaction between tertiles of perfusate oxygenation and haematocrit on acute kidney injury (pinteraction = 0.09): the middle and top tertiles of perfusate oxygenation were associated with a trend towards increased acute kidney injury risks among higher haematocrit children (adjusted odds ratio = 1.69, 95% confidence interval = [0.61, 4.66]; adjusted odds ratio = 2.25, 95% confidence interval = [0.84, 5.99], respectively) but not among normal haematocrit children (adjusted odds ratio = 1.16, 95% confidence interval = [0.46, 2.94]; adjusted odds ratio = 0.45, 95% confidence interval = [0.15, 1.36], respectively) compared with the bottom tertile. Conclusion: Preoperative haematocrit differences significantly modify the association of perfusate oxygenation with acute kidney injury, highlighting differential control of reoxygenation for different haematocrit children with Tetralogy of Fallot in the management of cardiopulmonary bypass.

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.

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