Acute kidney injury after neonatal cardiac surgery: A retrospective cohort study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Chao ¹ , CAO Zhongming ¹ , ZHONG Feng ¹ , WANG Sheng ² ,  LIANG Jiexian ¹

1. Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, P. R. China;
2. Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China;

Corresponding author：

LIANG Jiexian, Email: lijessy@msn.com

Keywords：

Acute kidney injury; neonatal congenital cardiac disease; risk factor

DOI：

10.7507/1007-4848.202212004

Video：

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Objective To summarize the clinical experience and risk factors for acute kidney injury (AKI) in neonates undergoing congenital cardiac surgery and demonstrate whether neonatal AKI after cardiac surgery was independently related to perioperative short-term outcomes. Methods Medical records of neonates undergoing congenital heart surgery from January 2014 to September 2021 were retrospectively reviewed. The patients were divided into an AKI group and a non-AKI group according to whether the AKI occured after the surgery. Multivariate logistic analysis was performed to analyze the risk factors for postoperative AKI and the relationship between postoperative AKI and postoperative short-term outcomes. Results A total of 609 patients were included. There were 395 males and 214 females with an age at surgery of 1.0-28.0 d and weight of 1.9-4.8 kg. After cardiac surgery, 139 neonates developed AKI. Multivariate logistic analysis showed that less intraoperative urine output [OR=0.96, 95%CI (0.94, 0.99), P=0.005], more intraoperative infusion of red blood cells [OR=1.49, 95%CI (1.16, 1.91), P=0.002], longer intraoperative deep hypothermic circulatory arrest time [OR=1.02, 95%CI (1.00, 1.04), P=0.020], higher vasoactive-inotropic score [OR=1.03, 95%CI (1.01, 1.04), P<0.001] and elevated lactate (increasing by 5 mmol/L) [OR=2.90, 95%CI (1.76, 4.76), P<0.001] when transferred to ICU were independent risk factors for AKI. AKI was an independent risk factor for increased in-hospital mortality [OR=12.61, 95%CI (3.00, 37.48), P<0.001]. Conclusion Less intraoperative urine output, more intraoperative infusion of red blood cells, longer intraoperative deep hypothermic circulatory arrest time, higher vasoactive-inotropic score and elevated lactate when transferred to ICU are independent risk factors for AKI. Furthermore, AKI is an independent risk factor for perioperative death after cardiac surgery.

Citation： LU Chao, CAO Zhongming, ZHONG Feng, WANG Sheng, LIANG Jiexian. Acute kidney injury after neonatal cardiac surgery: A retrospective cohort study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(9): 1294-1299. doi: 10.7507/1007-4848.202212004 Copy

1.	Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol, 2019, 60(1): 3-11.
2.	Van den Eynde J, Cloet N, Van Lerberghe R, et al. Strategies to prevent acute kidney injury after pediatric cardiac surgery: A network meta-analysis. Clin J Am Soc Nephrol, 2021, 16(10): 1480-1490.
3.	Ueno K, Shiokawa N, Takahashi Y, et al. Kidney disease: Improving global outcomes in neonates with acute kidney injury after cardiac surgery. Clin Exp Nephrol, 2020, 24(2): 167-173.
4.	Beken S, Akbulut BB, Albayrak E, et al. Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery. Pediatr Nephrol, 2021, 36(7): 1923-1929.
5.	Aoun B, Daher GA, Daou KN, et al. Acute kidney injury post-cardiac surgery in infants and children: A single-center experience in a developing country. Front Pediatr, 2021, 9: 637463.
6.	Hirano D, Ito A, Yamada A, et al. Independent risk factors and 2-year outcomes of acute kidney injury after surgery for congenital heart disease. Am J Nephrol, 2017, 46(3): 204-209.
7.	Sasaki J, Rodriguez Z, Alten JA, et al. Epidemiology of neonatal acute kidney injury after cardiac surgery without cardiopulmonary bypass. Ann Thorac Surg, 2022, 114(5): 1786-1792.
8.	Jetton JG, Boohaker LJ, Sethi SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): A multicentre, multinational, observational cohort study. Lancet Child Adolesc Health, 2017, 1(3): 184-194.
9.	Guan C, Li C, Xu L, et al. Risk factors of cardiac surgery-associated acute kidney injury: Development and validation of a perioperative predictive nomogram. J Nephrol, 2019, 32(6): 937-945.
10.	Butts RJ, Scheurer MA, Atz AM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol, 2012, 33(4): 633-638.
11.	O'Brien SM, Clarke DR, Jacobs JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg, 2009, 138(5): 1139-1153.
12.	Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol, 2014, 41(3): 487-502.
13.	Ueno K, Seki S, Shiokawa N, et al. Validation of acute kidney injury according to the modified KDIGO criteria in infants after cardiac surgery for congenital heart disease. Nephrology (Carlton), 2019, 24(3): 294-300.
14.	Namachivayam SP. Neonatal cardiac surgery and acute kidney injury: Early risk forecasting is important. Ann Thorac Surg, 2022, 114(5): 1792-1793.
15.	Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatr Nephrol, 2017, 32(9): 1509-1517.
16.	Pande CK, Noll L, Afonso N, et al. Neurodevelopmental outcomes in infants with cardiac surgery associated acute kidney injury. Ann Thorac Surg, 2022, 114(6): 2347-2354.
17.	Xu X, Nie S, Zhang A, et al. Acute kidney injury among hospitalized children in China. Clin J Am Soc Nephrol, 2018, 13(12): 1791-1800.
18.	Van den Eynde J, Delpire B, Jacquemyn X, et al. Risk factors for acute kidney injury after pediatric cardiac surgery: A meta-analysis. Pediatr Nephrol, 2022, 37(3): 509-519.
19.	Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation, 1995, 92(8): 2226-2235.
20.	Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2): 234-238.
21.	Kim-Campbell N, Gretchen C, Ritov VB, et al. Bioactive oxylipins in infants and children with congenital heart disease undergoing pediatric cardiopulmonary bypass. Pediatr Crit Care Med, 2020, 21(1): 33-41.
22.	Shukla I, Hanson SJ, Yan K, et al. Vasoactive-inotropic score and vasoactive-ventilation-renal score as outcome predictors for children on extracorporeal membrane oxygenation. Front Pediatr, 2021, 9: 769932.
23.	Radovic M, Bojic S, Kotur-Stevuljevic J, et al. Serum lactate as reliable biomarker of acute kidney injury in low-risk cardiac surgery patients. J Med Biochem, 2019, 38(2): 118-125.
24.	Minton J. Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol, 2017, 49(1): 7-15.
25.	Mak NT, Iqbal S, de Varennes B, et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg, 2016, 11: 33.
26.	Kulyabin YY, Bogachev-Prokophiev AV, Soynov IA, et al. Clinical assessment of perfusion techniques during surgical repair of coarctation of aorta with aortic arch hypoplasia in neonates: A pilot prospective randomized study. Semin Thorac Cardiovasc Surg, 2020, 32(4): 860-871.
27.	Selewski DT, Charlton JR, Jetton JG, et al. Neonatal acute kidney injury. Pediatrics, 2015, 136(2): e463-e473.
28.	Alkhairy S, Celi LA, Feng M, et al. Acute kidney injury detection using refined and physiological-feature augmented urine output. Sci Rep, 2021, 11(1): 19561.
29.	Lu C, Yu L, Wei J, et al. Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: A retrospective observational study. Ther Clin Risk Manag, 2019, 15: 851-860.
30.	Williams GD, Cohen RS. Perioperative management of low birth weight infants for open-heart surgery. Paediatr Anaesth, 2011, 21(5): 538-553.

1. Yuan SM. Acute kidney injury after pediatric cardiac surgery. Pediatr Neonatol, 2019, 60(1): 3-11.
2. Van den Eynde J, Cloet N, Van Lerberghe R, et al. Strategies to prevent acute kidney injury after pediatric cardiac surgery: A network meta-analysis. Clin J Am Soc Nephrol, 2021, 16(10): 1480-1490.
3. Ueno K, Shiokawa N, Takahashi Y, et al. Kidney disease: Improving global outcomes in neonates with acute kidney injury after cardiac surgery. Clin Exp Nephrol, 2020, 24(2): 167-173.
4. Beken S, Akbulut BB, Albayrak E, et al. Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery. Pediatr Nephrol, 2021, 36(7): 1923-1929.
5. Aoun B, Daher GA, Daou KN, et al. Acute kidney injury post-cardiac surgery in infants and children: A single-center experience in a developing country. Front Pediatr, 2021, 9: 637463.
6. Hirano D, Ito A, Yamada A, et al. Independent risk factors and 2-year outcomes of acute kidney injury after surgery for congenital heart disease. Am J Nephrol, 2017, 46(3): 204-209.
7. Sasaki J, Rodriguez Z, Alten JA, et al. Epidemiology of neonatal acute kidney injury after cardiac surgery without cardiopulmonary bypass. Ann Thorac Surg, 2022, 114(5): 1786-1792.
8. Jetton JG, Boohaker LJ, Sethi SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): A multicentre, multinational, observational cohort study. Lancet Child Adolesc Health, 2017, 1(3): 184-194.
9. Guan C, Li C, Xu L, et al. Risk factors of cardiac surgery-associated acute kidney injury: Development and validation of a perioperative predictive nomogram. J Nephrol, 2019, 32(6): 937-945.
10. Butts RJ, Scheurer MA, Atz AM, et al. Comparison of maximum vasoactive inotropic score and low cardiac output syndrome as markers of early postoperative outcomes after neonatal cardiac surgery. Pediatr Cardiol, 2012, 33(4): 633-638.
11. O'Brien SM, Clarke DR, Jacobs JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg, 2009, 138(5): 1139-1153.
12. Jetton JG, Askenazi DJ. Acute kidney injury in the neonate. Clin Perinatol, 2014, 41(3): 487-502.
13. Ueno K, Seki S, Shiokawa N, et al. Validation of acute kidney injury according to the modified KDIGO criteria in infants after cardiac surgery for congenital heart disease. Nephrology (Carlton), 2019, 24(3): 294-300.
14. Namachivayam SP. Neonatal cardiac surgery and acute kidney injury: Early risk forecasting is important. Ann Thorac Surg, 2022, 114(5): 1792-1793.
15. Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatr Nephrol, 2017, 32(9): 1509-1517.
16. Pande CK, Noll L, Afonso N, et al. Neurodevelopmental outcomes in infants with cardiac surgery associated acute kidney injury. Ann Thorac Surg, 2022, 114(6): 2347-2354.
17. Xu X, Nie S, Zhang A, et al. Acute kidney injury among hospitalized children in China. Clin J Am Soc Nephrol, 2018, 13(12): 1791-1800.
18. Van den Eynde J, Delpire B, Jacquemyn X, et al. Risk factors for acute kidney injury after pediatric cardiac surgery: A meta-analysis. Pediatr Nephrol, 2022, 37(3): 509-519.
19. Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation, 1995, 92(8): 2226-2235.
20. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2): 234-238.
21. Kim-Campbell N, Gretchen C, Ritov VB, et al. Bioactive oxylipins in infants and children with congenital heart disease undergoing pediatric cardiopulmonary bypass. Pediatr Crit Care Med, 2020, 21(1): 33-41.
22. Shukla I, Hanson SJ, Yan K, et al. Vasoactive-inotropic score and vasoactive-ventilation-renal score as outcome predictors for children on extracorporeal membrane oxygenation. Front Pediatr, 2021, 9: 769932.
23. Radovic M, Bojic S, Kotur-Stevuljevic J, et al. Serum lactate as reliable biomarker of acute kidney injury in low-risk cardiac surgery patients. J Med Biochem, 2019, 38(2): 118-125.
24. Minton J. Sidebotham DA. Hyperlactatemia and cardiac surgery. J Extra Corpor Technol, 2017, 49(1): 7-15.
25. Mak NT, Iqbal S, de Varennes B, et al. Outcomes of post-cardiac surgery patients with persistent hyperlactatemia in the intensive care unit: A matched cohort study. J Cardiothorac Surg, 2016, 11: 33.
26. Kulyabin YY, Bogachev-Prokophiev AV, Soynov IA, et al. Clinical assessment of perfusion techniques during surgical repair of coarctation of aorta with aortic arch hypoplasia in neonates: A pilot prospective randomized study. Semin Thorac Cardiovasc Surg, 2020, 32(4): 860-871.
27. Selewski DT, Charlton JR, Jetton JG, et al. Neonatal acute kidney injury. Pediatrics, 2015, 136(2): e463-e473.
28. Alkhairy S, Celi LA, Feng M, et al. Acute kidney injury detection using refined and physiological-feature augmented urine output. Sci Rep, 2021, 11(1): 19561.
29. Lu C, Yu L, Wei J, et al. Predictors of postoperative outcomes in infants with low birth weight undergoing congenital heart surgery: A retrospective observational study. Ther Clin Risk Manag, 2019, 15: 851-860.
30. Williams GD, Cohen RS. Perioperative management of low birth weight infants for open-heart surgery. Paediatr Anaesth, 2011, 21(5): 538-553.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Acute kidney injury after neonatal cardiac surgery: A retrospective cohort study in a single center

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