Prognosis of acute kidney injury after total cavopulmonary connection: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Chongjian ,  LUO Dandong , LI Xiaofeng , ZHU Weizhong

Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, 510080, P.R.China;

Corresponding author：

LUO Dandong, Email: iamchop@163.com

Keywords：

Total cavopulmonary connection; acute kidney injury; prognosis

DOI：

10.7507/1007-4848.201909085

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Objective To investigate the prevalence, severity and consequences of acute kidney injury (AKI) in the patients who underwent total cavopulmonary connection (TCPC).Methods The clinical data of TCPC patients in our center from January 1, 2010 to December 31, 2014 were collected and retrospectively analyzed. The patients with renal replacement therapy, missing serum creatinine data before operation or combined with valve procedures were excluded. We identified whether AKI was associated with hospital length of stay, ICU duration, mechanical ventilation duration, hospital acquired infection, and early mortality by univariable and multivariable analyses.Results A total of 163 patients were included. AKI occurred in 57% of patients (n=93), mild AKI in 26.4% (n=43), moderate AKI in 12.3% (n=20) and severe AKI in 18.4% (n=30). Compared with the no AKI group, the AKI group had higher hospital acquired infection rate (15.1% vs. 0.0%, P<0.001). AKI was independently associated with hospital length of stay (median, 10 d, 95%CI 3.9-16.0, P=0.001), ICU duration (median, 103.9, 95%CI 48.6-159.2, P<0.001) , but not associated with mechanical ventilation duration (median, 8 h vs. 7 h, P=0.529).Conclusion Postoperative AKI in the patients undergoing TCPC is common. AKI is associated with higher hospital acquired infection rate, longer hospital length of stay and ICU duration, but not associated with mechanical ventilation duration.

Citation： ZHANG Chongjian, LUO Dandong, LI Xiaofeng, ZHU Weizhong. Prognosis of acute kidney injury after total cavopulmonary connection: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 147-151. doi: 10.7507/1007-4848.201909085 Copy

1.	王旭冬, 车妙琳, 谢波, 等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6): 619-623.
2.	Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
3.	Madsen NL, Goldstein SL, Frøslev T, et al. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int, 2017, 92(3): 751-756.
4.	刘巍, 刘锦纷, 徐志伟, 等. 单中心 116 例一期全腔静脉肺动脉连接术的临床研究. 中国胸心血管外科临床杂志, 2016, 23(2): 142-146.
5.	Patterson T, Hehir DA, Buelow M, et al. Hemodynamic profile of acute kidney injury following the fontan procedure: impact of renal perfusion pressure. World J Pediatr Congenit Heart Surg, 2017, 8(3): 367-375.
6.	Broda CR, Sriraman H, Wadhwa D, et al. Renal dysfunction is associated with higher central venous pressures in patients with Fontan circulation. Congenit Heart Dis, 2018, 13(4): 602-607.
7.	Cui Y, Qu J, Liang H, et al. Relationship between perioperative N-terminal pro-brain natriuretic peptide and maximum inotropic score in children after cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(6): 2619-2621.
8.	Andrassy KM. Comments on 'KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease'. Kidney Int, 2013, 84(3): 622-623.
9.	Algaze CA, Koth AM, Faberowski LW, et al. Acute kidney injury in patients undergoing the extracardiac fontan operation with and without the use of cardiopulmonary bypass. Pediatr Crit Care Med, 2017, 18(1): 34-43.
10.	Mancini E, Caramelli F, Ranucci M, et al. Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis? Hemodial Int, 2012, 16(2): 252-258.
11.	Ricci Z, Di Nardo M, Iacoella C, et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol, 2013, 34(6): 1404-1408.
12.	Yi Q, Li K, Jian Z, et al. Risk factors for acute kidney injury after cardiovascular surgery: evidence from 2, 157 cases and 49, 777 controls - a meta-analysis. Cardiorenal Med, 2016, 6(3): 237-250.
13.	SooHoo M, Griffin B, Jovanovich A, et al. Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review. Pediatr Nephrol, 2018, 33(7): 1235-1242.
14.	Lai TS, Wang CY, Pan SC, et al. Risk of developing severe sepsis after acute kidney injury: a population-based cohort study. Crit Care, 2013, 17(5): R231.
15.	Griffin BR, You Z, Holmen J, et al. Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis. PLoS One, 2019, 14(6): e0217935.
16.	Blinder JJ, Goldstein SL, Lee VV, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg, 2012, 143(2): 368-374.
17.	Esch JJ, Salvin JM, Thiagarajan RR, et al. Acute kidney injury after Fontan completion: Risk factors and outcomes. J Thorac Cardiovasc Surg, 2015, 150(1): 190-197.
18.	Heung M, Steffick DE, Zivin K, et al. Acute kidney injury recovery pattern and subsequent risk of CKD: An analysis of veterans health administration data. Am J Kidney Dis, 2016, 67(5): 742-752.

1. 王旭冬, 车妙琳, 谢波, 等. 急性肾损伤定义及分期系统评估心脏手术患者预后的临床价值. 中国胸心血管外科临床杂志, 2012, 19(6): 619-623.
2. Hu J, Chen R, Liu S, et al. Global incidence and outcomes of adult patients with acute kidney injury after cardiac surgery: a systematic review and meta-analysis. J Cardiothorac Vasc Anesth, 2016, 30(1): 82-89.
3. Madsen NL, Goldstein SL, Frøslev T, et al. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int, 2017, 92(3): 751-756.
4. 刘巍, 刘锦纷, 徐志伟, 等. 单中心 116 例一期全腔静脉肺动脉连接术的临床研究. 中国胸心血管外科临床杂志, 2016, 23(2): 142-146.
5. Patterson T, Hehir DA, Buelow M, et al. Hemodynamic profile of acute kidney injury following the fontan procedure: impact of renal perfusion pressure. World J Pediatr Congenit Heart Surg, 2017, 8(3): 367-375.
6. Broda CR, Sriraman H, Wadhwa D, et al. Renal dysfunction is associated with higher central venous pressures in patients with Fontan circulation. Congenit Heart Dis, 2018, 13(4): 602-607.
7. Cui Y, Qu J, Liang H, et al. Relationship between perioperative N-terminal pro-brain natriuretic peptide and maximum inotropic score in children after cardiac surgery. J Thorac Cardiovasc Surg, 2018, 155(6): 2619-2621.
8. Andrassy KM. Comments on 'KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease'. Kidney Int, 2013, 84(3): 622-623.
9. Algaze CA, Koth AM, Faberowski LW, et al. Acute kidney injury in patients undergoing the extracardiac fontan operation with and without the use of cardiopulmonary bypass. Pediatr Crit Care Med, 2017, 18(1): 34-43.
10. Mancini E, Caramelli F, Ranucci M, et al. Is time on cardiopulmonary bypass during cardiac surgery associated with acute kidney injury requiring dialysis? Hemodial Int, 2012, 16(2): 252-258.
11. Ricci Z, Di Nardo M, Iacoella C, et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol, 2013, 34(6): 1404-1408.
12. Yi Q, Li K, Jian Z, et al. Risk factors for acute kidney injury after cardiovascular surgery: evidence from 2, 157 cases and 49, 777 controls - a meta-analysis. Cardiorenal Med, 2016, 6(3): 237-250.
13. SooHoo M, Griffin B, Jovanovich A, et al. Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review. Pediatr Nephrol, 2018, 33(7): 1235-1242.
14. Lai TS, Wang CY, Pan SC, et al. Risk of developing severe sepsis after acute kidney injury: a population-based cohort study. Crit Care, 2013, 17(5): R231.
15. Griffin BR, You Z, Holmen J, et al. Incident infection following acute kidney injury with recovery to baseline creatinine: A propensity score matched analysis. PLoS One, 2019, 14(6): e0217935.
16. Blinder JJ, Goldstein SL, Lee VV, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg, 2012, 143(2): 368-374.
17. Esch JJ, Salvin JM, Thiagarajan RR, et al. Acute kidney injury after Fontan completion: Risk factors and outcomes. J Thorac Cardiovasc Surg, 2015, 150(1): 190-197.
18. Heung M, Steffick DE, Zivin K, et al. Acute kidney injury recovery pattern and subsequent risk of CKD: An analysis of veterans health administration data. Am J Kidney Dis, 2016, 67(5): 742-752.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Prognosis of acute kidney injury after total cavopulmonary connection: A retrospective cohort study

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