Skip to main content

Advertisement

SpringerLink
Log in

Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Cardiac surgery is a known risk factor for acute kidney injury (AKI) in children. However, cardiac surgery-associated AKI (CS-AKI) in neonates has not been well studied. The objectives of this study were: (1) to describe the epidemiology of CS-AKI in neonates utilizing the Acute Kidney Injury Network (AKIN) definition, (2) to identify risk factors for neonatal CS-AKI, and (3) to determine if neonatal CS-AKI is associated with increased morbidity and mortality.

Methods

This was a retrospective study involving 122 neonates (≤28 days) undergoing cardiac surgery from 2006 to 2009. Neonates with and without AKI were identified using serum creatinine (SCr) and urine output (UO) data.

Results

Cardiac surgery-AKI occurred in 76 (62 %) neonates, of whom 22 (29 %) were AKIN stage 1, 19 (25 %) were stage 2, and 35 (46 %) were stage 3. AKI mostly occurred early as 75 % of patients achieved their maximal AKIN stage within the first 48 h post-operatively. In the multivariate analysis, cardiopulmonary bypass duration of ≥120 min was independently associated with AKI [odds ratio (OR) 2.53, 95 % confidence interval (CI) 1.03–6.30]. Severe AKI (AKIN stage 3) was independently associated with mortality (OR 6.70, 95 % CI 1.08–41.50) and a longer stay in the pediatric intensive care unit (hazard ratio 9.09, 95 % CI 1.35–60.95). The majority of severe AKI cases (65 %) were identified with AKIN UO criteria alone without significant rises in SCr.

Conclusions

Cardiac surgery-AKI is common in neonates when the AKIN definition is utilized and is associated with higher morbidity and mortality, especially in those with more severe AKI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: Effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374

    Google Scholar 

  2. Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O (2009) A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 76:885–892

    Article  PubMed  CAS  Google Scholar 

  3. Skippen PW, Krahn GE (2005) Acute renal failure in children undergoing cardiopulmonary bypass. Crit Care Resusc 7:286–291

    PubMed  CAS  Google Scholar 

  4. Pedersen KR, Hjortdal VE, Christensen S, Pedersen J, Hjortholm K, Larsen SH, Povlsen JV (2008) Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int Suppl (108):S81–86

  5. Pedersen KR, Povlsen JV, Christensen S, Pedersen J, Hjortholm K, Larsen SH, Hjortdal VE (2007) Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta Anaesthesiol Scand 51:1344–1349

    Article  PubMed  CAS  Google Scholar 

  6. Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162(120–127):e121

    Google Scholar 

  7. Sethi SK, Goyal D, Yadav DK, Shukla U, Kajala PL, Gupta VK, Grover V, Kapoor P, Juneja A (2011) Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 15:529–534

    Article  PubMed  Google Scholar 

  8. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, Schneider J (2012) Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94:1589–1595

    Article  PubMed  Google Scholar 

  9. Chan KL, Ip P, Chiu CS, Cheung YF (2003) Peritoneal dialysis after surgery for congenital heart disease in infants and young children. Ann Thorac Surg 76:1443–1449

    Article  PubMed  Google Scholar 

  10. Canfield MA, Honein MA, Yuskiv N, Xing J, Mai CT, Collins JS, Devine O, Petrini J, Ramadhani TA, Hobbs CA, Kirby RS (2006) National estimates and race/ethnic-specific variation of selected birth defects in the United States, 1999–2001. Birth Defects Res A Clin Mol Teratol 76:747–756

    Article  PubMed  CAS  Google Scholar 

  11. Bird TM, Hobbs CA, Cleves MA, Tilford JM, Robbins JM (2006) National rates of birth defects among hospitalized newborns. Birth Defects Res A Clin Mol Teratol 76:762–769

    Article  PubMed  CAS  Google Scholar 

  12. Tennant PW, Pearce MS, Bythell M, Rankin J (2010) 20-year survival of children born with congenital anomalies: a population-based study. Lancet 375:649–656

    Article  PubMed  Google Scholar 

  13. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8:R204–R212

    Article  PubMed  Google Scholar 

  14. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31

    Article  PubMed  Google Scholar 

  15. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035

    Article  PubMed  CAS  Google Scholar 

  16. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK, Moffett BS, Goldstein SL (2008) Ascertainment and epidemiology of acute kidney injury varies with definition interpretation. Clin J Am Soc Nephrol 3:948–954

    Article  PubMed  Google Scholar 

  17. Ozcakar ZB, Yalcinkaya F, Altas B, Ergun H, Kendirli T, Ates C, Elhan AH, Ekim M (2009) Application of the new classification criteria of the Acute Kidney Injury Network: a pilot study in a pediatric population. Pediatr Nephrol 24:1379–1384

    Article  PubMed  Google Scholar 

  18. Duzova A, Bakkaloglu A, Kalyoncu M, Poyrazoglu H, Delibas A, Ozkaya O, Peru H, Alpay H, Soylemezoglu O, Gur-Guven A, Bak M, Bircan Z, Cengiz N, Akil I, Ozcakar B, Uncu N, Karabay-Bayazit A, Sonmez F (2010) Etiology and outcome of acute kidney injury in children. Pediatr Nephrol 25:1453–1461

    Article  PubMed  Google Scholar 

  19. Plotz FB, Bouma AB, van Wijk JA, Kneyber MC, Bokenkamp A (2008) Pediatric acute kidney injury in the ICU: an independent evaluation of pRIFLE criteria. Intensive Care Med 34:1713–1717

    Article  PubMed  Google Scholar 

  20. Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 59:523–530

    Article  PubMed  Google Scholar 

  21. Koralkar R, Ambalavanan N, Levitan EB, McGwin G, Goldstein S, Askenaz D (2011) Acute kidney injury reduces survival in very low birth weight infants. Pediatr Res 69:354–358

    Article  PubMed  Google Scholar 

  22. Kist-van Holthe tot Echten JE, Goedvolk CA, Doornaar MB, van der Vorst MM, Bosman-Vermeeren JM, Brand R, van der Heijden AJ, Schoof PH, Hazekamp MG (2001) Acute renal insufficiency and renal replacement therapy after pediatric cardiopulmonary bypass surgery. Pediatr Cardiol 22:321–326

    PubMed  CAS  Google Scholar 

  23. Askenazi DJ, Ambalavanan N, Goldstein SL (2009) Acute kidney injury in critically ill newborns: what do we know? What do we need to learn? Pediatr Nephrol 24:265–274

    Article  PubMed  Google Scholar 

  24. Gupta BD, Sharma P, Bagla J, Parakh M, Soni JP (2005) Renal failure in asphyxiated neonates. Indian Pediatr 42:928–934

    PubMed  CAS  Google Scholar 

  25. Mathur NB, Agarwal HS, Maria A (2006) Acute renal failure in neonatal sepsis. Indian J Pediatr 73:499–502

    Article  PubMed  CAS  Google Scholar 

  26. Agras PI, Tarcan A, Baskin E, Cengiz N, Gurakan B, Saatci U (2004) Acute renal failure in the neonatal period. Ren Fail 26:305–309

    Article  PubMed  Google Scholar 

  27. Norman ME, Asadi FK (1979) A prospective study of acute renal failure in the newborn infant. Pediatrics 63:475–479

    PubMed  CAS  Google Scholar 

  28. Michael M, Kuehnle I, Goldstein SL (2004) Fluid overload and acute renal failure in pediatric stem cell transplant patients. Pediatr Nephrol 19:91–95

    Article  PubMed  Google Scholar 

  29. Goldstein SL, Currier H, Graf C, Cosio CC, Brewer ED, Sachdeva R (2001) Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 107:1309–1312

    Article  PubMed  CAS  Google Scholar 

  30. Foland JA, Fortenberry JD, Warshaw BL, Pettignano R, Merritt RK, Heard ML, Rogers K, Reid C, Tanner AJ, Easley KA (2004) Fluid overload before continuous hemofiltration and survival in critically ill children: a retrospective analysis. Crit Care Med 32:1771–1776

    Article  PubMed  Google Scholar 

  31. Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, Kim RW, Parikh CR (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39:1493–1499

    Article  PubMed  Google Scholar 

  32. Haycock GB (1998) Development of glomerular filtration and tubular sodium reabsorption in the human fetus and newborn. Br J Urol 81[Suppl 2]:33–38

    PubMed  Google Scholar 

  33. Liu KD, Thompson BT, Ancukiewicz M, Steingrub JS, Douglas IS, Matthay MA, Wright P, Peterson MW, Rock P, Hyzy RC, Anzueto A, Truwit JD (2011) Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes. Crit Care Med 39:2665–2671

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Nephrology, British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC, Canada, V6H3V4

    Abdullah AlAbbas, Douglas Matsell & Cherry Mammen

  2. Division of Cardiothoracic Surgery, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Andrew Campbell

  3. Division of Critical Care, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Peter Skippen

  4. Division of Cardiology, British Columbia Children’s Hospital, Vancouver, BC, Canada

    Derek Human

Authors
  1. Abdullah AlAbbas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Skippen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Derek Human
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Douglas Matsell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cherry Mammen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Abdullah AlAbbas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

AlAbbas, A., Campbell, A., Skippen, P. et al. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 28, 1127–1134 (2013). https://doi.org/10.1007/s00467-013-2454-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-013-2454-3

Keywords

Search

Navigation