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Li Y, Bie D, Xiong C, Shi S, Fang Z, Lu Z, Wang J. The clinical outcomes of acute kidney injury substages based on serum cystatin C in pediatric patients undergoing cardiac surgery. Ren Fail 2025; 47:2466114. [PMID: 39980307 PMCID: PMC11849008 DOI: 10.1080/0886022x.2025.2466114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2024] [Revised: 02/05/2025] [Accepted: 02/07/2025] [Indexed: 02/22/2025] Open
Abstract
BACKGROUND Multiple biomarkers have been identified by previous studies to diagnose acute kidney injury (AKI). The combination of biomarkers with conventional criteria to define AKI substages in order to identify high-risk patients and improve diagnostic accuracy was recommended. Our study aimed to explore the incidence of AKI substages defined by serum cystatin C (CysC), determine whether AKI substages diagnosed with combined CysC criteria were associated with worse outcomes. METHODS We prospectively included 2519 pediatric patients (<16 years) undergoing cardiac surgery with cardiopulmonary bypass (CPB) in our cohort between March 2022 and February 2023 in Fuwai Hospital. Demographic and clinical variables were collected. To define AKI substages, Kidney Disease: Improving Global Outcomes AKI definition (based on serum creatinine (SCr) or CysC) was used. The association between AKI exposure and outcomes including length of intensive care unit stay (LOIS), duration of mechanical ventilation (DMV), length of hospital stay (LOHS), and 30-day mortality was assessed. In addition, we determined areas under the receiver operating characteristic (ROC) curve and cutoff value of CysC preoperatively and postoperatively to predict AKI. RESULTS Five hundred and seven (20.8%) patients developed SCr-AKI, with 337 (13.8%) in stage 1, 77 (3.2%) in stage 2 and 93 (3.8%) in stage 3, respectively. Of the 1925 patients without SCr-AKI, 256 (14.3%) met the definition of sub-AKI. Of the 507 patients with SCr-AKI, 281 (55.4%) patients were defined as AKI substage A, while others (226, 44.6%) were defined as AKI substage B. After adjusting for body surface area, neonates, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality score ≥ 4, previous sternotomy and CPB time > 120 min, the postoperative LOIS, LOHS, and DMV were prolonged with increasing hospitalization expense (p < .05) in patients with SCr-AKI and/or CysC-AKI. Meanwhile, only the hospitalization expense was increased in patients with SCr-AKI (p < .05) after the same adjustment. The area under curves was 0.691, 0.720, and 0.817 respectively, in ROC curves of preoperative, relative variation, or postoperative serum CysC. DeLong's test showed that postoperative serum CysC might have better diagnostic performance characteristics than preoperative or relative variation of CysC (p < .001), with cutoff point at 1.29 mg/dL (specificity, 0.77; sensitivity, 0.71). CONCLUSIONS Our analysis indicates defining AKI with both CysC and SCr might more significantly affect clinical outcome associations in pediatric patients undergoing cardiac surgery. Moreover, the serum CysC cutoff of 1.29 mg/dL postoperatively is a valuable threshold for AKI risk assessment to define AKI subtypes.
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Affiliation(s)
- Yinan Li
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyun Bie
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Xiong
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Shi
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongrong Fang
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongyuan Lu
- Department of Pediatric Cardiac Intensive Care Unit, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Wang
- Department of Anesthesiology, Fuwai Hospital, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kvaran RB, Skagervik A, Pernbro F, Romlin B, Molin M, Wåhlander H, Aass HCD, Vistnes M, Ojala T, Thorlacius EM, Castellheim AG. Multivariable Modeling of Postoperative Risk in Infant Cardiac Surgery: Integrating Clinical Variables and 20 Inflammatory Biomarkers. Acta Anaesthesiol Scand 2025; 69:e70073. [PMID: 40492379 DOI: 10.1111/aas.70073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2025] [Revised: 04/30/2025] [Accepted: 06/02/2025] [Indexed: 06/12/2025]
Abstract
INTRODUCTION Cardiac surgery in infants often triggers a severe inflammatory response. The role of biomarkers in predicting clinical outcomes in this group of patients has been debated in the literature. This study aimed to investigate the predictive value of 20 inflammatory biomarkers, in combination with clinical data, for acute kidney injury, ventilator support duration, and inotropic score following infant cardiac surgery by developing and comparing three models: Clinical-Data-Only, Biomarker-Only, and Combined. METHODS This secondary analysis of the MiLe-1 study included infants undergoing surgery with cardiopulmonary bypass. Biomarkers were measured before and after CPB. Using BIC-guided logistic regression, we developed and compared three multivariable models-Clinical-Data-Only, Biomarker-Only, and Combined-for each outcome. Model performance was assessed using c-statistics and p-contrast tests. RESULTS Regarding AKI risk prediction, the c-statistics for Biomarker-Only, Clinical-Data-Only, and Combined Model were 0.79, 0.60, and 0.78 respectively. The difference in performance between the Combined and Clinical-Data-Only Models was statistically significant (p < 0.001). Concerning ventilator support time prediction, the c-statistics were 0.80, 0.72, and 0.77 for the models respectively (p-contrast = 0.10). As for inotropic score prediction, the c-statistics were 0.83, 0.77, and 0.85 for the models (p-contrast = 0.007). CONCLUSION Inflammatory biomarkers may enhance risk stratification for postoperative outcomes in infant cardiac surgery. However, given the exploratory nature of this study, further validation in larger and more diverse cohorts is needed.
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Affiliation(s)
- Rúnar Bragi Kvaran
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Andreas Skagervik
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Fredrik Pernbro
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Birgitta Romlin
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Mattias Molin
- Statistiska Konsultgruppen Sweden, Gothenburg, Sweden
| | - Håkan Wåhlander
- Region Västra Götaland, Sahlgrenska University Hospital, Children's Heart Center, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Maria Vistnes
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Tiina Ojala
- Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Elin M Thorlacius
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Albert Gyllencreutz Castellheim
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children's Hospital, Gothenburg, Sweden
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Leballo G, Arbee-Kalidas N, Kebalepile MM, Chakane PM. The use of ultrasonography in the diagnosis and management of Acute Kidney Injury and other forms renal dysfunction in the paediatric population: Systematic review protocol. PLoS One 2025; 20:e0325549. [PMID: 40531948 PMCID: PMC12176226 DOI: 10.1371/journal.pone.0325549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 05/14/2025] [Indexed: 06/22/2025] Open
Abstract
BACKGROUND Acute kidney injury remains one of the most prevalent complications in hospitalised patients, with an especially high incidence in the paediatric population. Its diverse pathophysiological aetiologies present significant challenges in its clinical diagnosis. Relying solely on serum creatinine levels and urine output measurements for diagnosis has been shown to be inadequate, particularly for early detection of the disease. The wide range of disease manifestations highlights the importance of exploring diagnostic techniques that can identify patients at risk before disease progression occurs, thereby allowing for the implementation of timely corrective measures. Point-of-care ultrasound is a valuable technique with the potential to aid in the early identification of at-risk patients. OBJECTIVE To describe ultrasound parameters associated with the development of acute kidney injury or renal dysfunction in the hospitalised paediatric patient, and to examine their association with its development. This will include an analysis of the specific ultrasound features that may predict or be associated with the occurrence of acute kidney injury, as well as their potential role in identifying at-risk paediatric patients, facilitating timely interventions to mitigate further kidney damage. METHODS A systematic review of existing literature will be performed to assess ultrasound modalities currently associated with the diagnosis of acute kidney injury in the paediatric population. The protocol for this review has been registered with PROSPERO (CDR42024547614) and was developed in accordance with the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA). A comprehensive search of scientific literature will be conducted across PubMed, Scopus, Cochrane Library, and CINAHL databases. The data search will be performed independently by the primary researchers (GL and NA), with any disagreements resolved by the third and fourth researchers (MK, PMC). The COVIDENCE Systematic Review Software® 2024 will be utilised for article exportation, review, and data extraction. The QUADAS-2 tool will be applied to assess the risk of bias in the diagnostic accuracy of the studies included in the review. CONCLUSION This protocol outlines a systematic review designed to evaluate the application of ultrasonography in identifying paediatric patients at risk of developing acute kidney injury and other forms of renal dysfunction. The review will critically assess the effectiveness of ultrasound techniques, including point-of-care ultrasound, in identifying acute kidney injury in children, with a particular emphasis on early detection. The findings from this review will contribute to a deeper understanding of the role of ultrasonography in clinical practice, with the potential to improve patient outcomes through earlier intervention. The ultrasound techniques identified, including Doppler imaging and flow measurements, will be employed in a subsequent prospective study within the paediatric population to evaluate their role, sensitivity, and accuracy.
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Affiliation(s)
- Gontse Leballo
- Department of Anaesthesiology, Charlotte Maxeke Johannesburg Academic, Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nabeela Arbee-Kalidas
- Department of Anaesthesiology, Charlotte Maxeke Johannesburg Academic, Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Moses Mogakolodi Kebalepile
- Department of Anaesthesiology, Charlotte Maxeke Johannesburg Academic, Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Palesa Motshabi Chakane
- Department of Anaesthesiology, Charlotte Maxeke Johannesburg Academic, Hospital, University of the Witwatersrand, Johannesburg, South Africa
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Eberle L, Matsubara M, Palm J, Schaeffer T, Osawa T, Niedermaier C, Heinisch PP, Piber N, Balling G, Hager A, Ewert P, Hörer J, Ono M. Cardiac surgery-associated acute kidney injury in neonatal Norwood procedure: incidence, risk factors and impact on mortality and outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2025; 40:ivaf132. [PMID: 40459849 PMCID: PMC12165726 DOI: 10.1093/icvts/ivaf132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2025] [Revised: 03/19/2025] [Accepted: 05/31/2025] [Indexed: 06/16/2025]
Abstract
OBJECTIVES Acute kidney injury commonly complicates congenital heart surgery with cardiopulmonary bypass, increasing morbidity and mortality. This study aimed to evaluate risk factors for postoperative acute kidney injury and its impact on outcomes after the Norwood procedure. METHODS Neonates undergoing the Norwood procedure from 2001 to 2022 were reviewed. Using modified neonatal Kidney Disease Improving Global Outcomes criteria, we assessed acute kidney injury and analysed its risk factors and impact on survival. RESULTS Among the 355 patients who were included, severe acute kidney injury occurred in 100 (28.2%). Risk factors were low weight at Norwood <2.5 kg (odds ratio: 3.0, P = 0.015) and extracorporeal membrane oxygenation support (odds ratio: 2.2, P = 0.013). Shunt type was not identified as a risk (P = 0.317). Acute kidney injury was an independent risk factor for in-hospital death (odds ratio 2.3, P = 0.010) but did not influence survival after hospital discharge (hazard ratio: 1.5, P = 0.230). The hazard ratio for mortality in patients with acute kidney injury compared to patients without acute kidney injury was 2.5, P < 0.001 with a modified Blalock-Taussig-Thomas shunt and 1.9, P = 0.010 with a right ventricle-to-pulmonary artery conduit. CONCLUSIONS Severe acute kidney injury occurred in approximately a quarter of patients after the Norwood procedure and is an independent risk for in-hospital mortality, both in patients with a modified Blalock-Taussig-Thomas shunt and right ventricle-to-pulmonary artery conduit.
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Affiliation(s)
- Laetitia Eberle
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Muneaki Matsubara
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Jonas Palm
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Takuya Osawa
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Carolin Niedermaier
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Paul Philipp Heinisch
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Gunter Balling
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
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Gimonge J, Muhunzi D, Edward Z, Kisenge R. The Incidence, Associated Factors and in-Hospital Outcomes of Cardiac-Surgery-Associated Acute Kidney Injury Among Children Undergoing Cardiac Surgery at Jakaya Kikwete Cardiac Institute. A Hospital-Based Prospective Cohort Study. Health Sci Rep 2025; 8:e70923. [PMID: 40524714 PMCID: PMC12168476 DOI: 10.1002/hsr2.70923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 05/07/2025] [Accepted: 05/27/2025] [Indexed: 06/19/2025] Open
Abstract
Background and Aims Cardiac surgery-associated acute kidney injury (CSA-AKI) is one of the serious complications that can potentially increase the risk of morbidity, long-term adverse effects and mortality. Despite the advances in the care and increased survival of children post-cardiac surgery, CSA-AKI is still a big problem with considerable morbidity and mortality in high-risk children. Prevention of CSA-AKI is important for survival and minimization of long-term adverse outcomes of children after cardiac surgery. This study aimed to determine the proportion of acute kidney injury, associated risk factors and in-hospital outcomes among children undergoing cardiac surgery at the Jakaya Kikwete Cardiac Institute (JKCI). Methodology A prospective cohort study was conducted to determine the proportion, risk factors, and in-hospital outcomes among children who developed cardiac surgery-associated acute kidney injury (CSA-AKI) at JKCI. Data collection was done using a structured questionnaire, Intensive care unit (ICU) chart review, and hospital records. Diagnosis of CSA-AKI was done based on KDIGO criteria. Serum creatinine was measured pre-operatively and subsequently, daily up to day seven postoperatively to determine the presence of CSA-AKI. Results A total of 210 children were recruited into the study, of which 120 (57.1%) were males. The median age of the study participants was 36 months. Of the recruited children, 23 (11.0%) developed cardiac surgery-associated acute kidney injury (CSA-AKI). Intraoperative hypotension [ARR = 2.7; 95% CI 1.37-5.26; p-value = 0.004], intraoperative platelet transfusion [ARR = 2.7; 95% CI 1.37-5.22; p-value = 0.004] and two or more days on mechanical ventilation [ARR = 2.3; 95% CI 1.1-4.71; p-value = 0.019] were found to be significantly associated with CSA-AKI. There were 8 (3.8%) deaths, of these, 7 (87.5%) were from children who developed CSA-AKI. Children who developed CSA-AKI had, on average, a longer ICU stay, with a mean difference of 1.959 days. Conclusion This study's findings highlighted the prevalence and severity of cardiac surgery associated with acute kidney injury in pediatric patients. The identified risk factors, such as intraoperative hypotension, platelet transfusion, and prolonged mechanical ventilation, provide crucial insights for improving patient outcomes. The study's results also emphasize the need for interventions targeting these modifiable factors to reduce mortality among children undergoing cardiac surgery.
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Affiliation(s)
- Joyce Gimonge
- Department of Pediatrics and Child HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - David Muhunzi
- School of Clinical MedicineMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
| | - Zawadi Edward
- Department of PediatricsJakaya Kikwete Cardiac InstituteDar es SalaamTanzania
| | - Rodrick Kisenge
- Department of Pediatrics and Child HealthMuhimbili University of Health and Allied SciencesDar es SalaamTanzania
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Xiao R, Luo M, Yu H, Zhang Y, Long F, Li W, Zhou R. Relationship between intraoperative blood pressure variability and postoperative acute kidney injury in pediatric cardiac surgery. Pediatr Nephrol 2025; 40:2071-2081. [PMID: 39870953 PMCID: PMC12031837 DOI: 10.1007/s00467-025-06659-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 11/29/2024] [Accepted: 12/21/2024] [Indexed: 01/29/2025]
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury (CSA-AKI) is a notably common complication in pediatrics, with an incidence rate ranging from 15 to 64%. This rate is significantly higher than that observed in adults. Currently, there is a lack of substantial evidence regarding the association between intraoperative blood pressure variability (BPV) during cardiac surgery with cardiopulmonary bypass (CPB) and the development of AKI in pediatric patients. METHODS This retrospective observational study encompassed children aged 0-7 years undergoing cardiac surgery with CPB. Intraoperative BPV was calculated using coefficients of variation (CVs) and the area under the curve (AUC). Univariate and multivariate analyses were employed to identify risk factors associated with CSA-AKI. RESULTS Among 570 patients (median age 1 year) reviewed, 36.1% developed CSA-AKI (68.9% risk stage, 22.8% injury stage, and 8.3% failure stage). After adjusting for other variables, male gender (OR = 2.044, 95% CI 1.297-3.222, P = 0.002), congenital heart surgery risk assessment grade (RACHS-1) classification ≥ 3 (OR = 0.510, 95% CI 0.307-0.846, P = 0.009), longer CPB time (OR = 1.022, 95% CI 1.007-1.037, P = 0.004) and higher peak value of intraoperative vasoactive inotropic score (VIS) (OR = 1.072, 95% CI 1.026-1.119, P = 0.002) were identified as independent risk factors for CSA-AKI. ± 30% AUCm was different in univariate analysis (P = 0.014), however, not statistically different in multifactor analysis (P = 0.610). CONCLUSION Greater BPV, specifically MAP variations exceeding 30% AUC during CPB, may be a potential risk factor for CSA-AKI in pediatric patients. Further large sample clinical studies are warranted to analyze the correlation between BPV and CSA-AKI.
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Affiliation(s)
- Rong Xiao
- Department of Anesthesiology, Xichang People's Hospital, Xichang, 615000, Sichuan, China
| | - Ming Luo
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Yan Zhang
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Feng Long
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Weina Li
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China
| | - Ronghua Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Wuhou District, Chengdu, 610000, Sichuan, China.
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Wachenbrunner J, Mast M, Böhnke J, Rübsamen N, Bode L, Karch A, Rathert H, Horke A, Beerbaum P, Marschollek M, Jack T, Böhne M. A rule-based clinical decision support system for detection of acute kidney injury after pediatric cardiac surgery. Comput Biol Med 2025; 193:110382. [PMID: 40409037 DOI: 10.1016/j.compbiomed.2025.110382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 04/23/2025] [Accepted: 05/12/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in children with congenital heart disease following open-heart surgery with cardiopulmonary bypass (CPB). Early AKI detection in critically ill children requires clinician expertise to compile various data from different sources within a stressful and time-sensitive environment. However, as electronic health records provide data in a machine-readable format, this process could be supported by computerized systems. Therefore, we developed a time-aware, rule-based clinical decision support system (CDSS) to detect, stage, and track temporal AKI progression in children. METHODS We integrated retrospective clinical routine data from n = 290 randomly selected cases (n = 263 patients, aged 0-17 years) who underwent cardiac surgery with CPB into a dataset. We adapted Kidney Disease: Improving Global Outcome (KDIGO) criteria, including serum creatinine, urine output, and estimated glomerular filtration rate, and translated them into computable rules for the CDSS. As a reference standard, patients were manually assessed by blinded clinical experts. RESULTS The AKI incidence, according to the reference standard, was n = 146 cases for stage 1, n = 58 for stage 2, and n = 20 for stage 3. The CDSS achieved sensitivities of 92.2 % (95 % CI: 86.8-95.5 %) for AKI stage 1, 88.1 % (95 % CI: 77.2-94.2 %) for stage 2, and 95 % (95 % CI: 70.5-99.3 %) for stage 3. The specificities were 97.0 % (95 % CI: 94.4-98.4 %), 98.5 % (95 % CI: 96.5-99.4 %), and 99.3 % (95 % CI: 97.3-99.8 %), respectively. CONCLUSIONS We demonstrated that a CDSS is able to perform a complex AKI detection and staging process, including 11 criteria across three stages. For accurate automated AKI detection, standardized machine-readable data of high data quality are required. CDSS with high diagnostic accuracy, like presented, can support clinical management and be used for surveillance and quality management. The prototypical use for surveillance and further studies, such as the development of prediction models, should demonstrate the system's benefits in the future.
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Affiliation(s)
- Janice Wachenbrunner
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Marcel Mast
- Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Hannover, Germany.
| | - Julia Böhnke
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Nicole Rübsamen
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Louisa Bode
- Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Hannover, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Henning Rathert
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hanover, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Hannover, Germany
| | - Thomas Jack
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany; Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Hannover, Germany
| | - Martin Böhne
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
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Lee J, Marshall T, Buck H, Pamela M, Daack-Hirsch S. Growth Failure in Children with Congenital Heart Disease. CHILDREN (BASEL, SWITZERLAND) 2025; 12:616. [PMID: 40426795 PMCID: PMC12110605 DOI: 10.3390/children12050616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2025] [Revised: 05/05/2025] [Accepted: 05/08/2025] [Indexed: 05/29/2025]
Abstract
Background/Objectives: Growth failure is a common complication in children with congenital heart disease (CHD), yet its underlying mechanisms and consequences remain incompletely understood. This review aims to provide a comprehensive overview of growth failure in children with CHD and outline a framework of factors contributing to this condition. Methods: To lay the foundation for this narrative review, several databases were searched using broad search terms related to CHD and growth failure. Results: Growth failure is most pronounced during the first year of life, but often improves after achieving hemodynamic stability through surgical or medical interventions. However, children with complex conditions, such as single-ventricle physiology or multiple heart defects, may experience persistent growth impairment due to chronic disease effects. Specific features of CHD-cyanosis, pulmonary hypertension, and low cardiac output-can further hinder growth by disrupting endocrine function and impairing musculoskeletal development. Long-term use of medications and exposure to repeated diagnostic procedures also contribute to growth failure. Beyond physical effects, growth failure profoundly influences neurodevelopment, psychosocial well-being, and survival outcomes. Based on our review, we have developed a knowledge map to better understand the complexities of growth failure in children with CHD. Conclusions: A thorough understanding of the multifaceted contributors to growth failure in CHD is essential for identifying high-risk children and devising strategies to support optimal growth. Integrating this knowledge into clinical practice can improve long-term outcomes for children with CHD.
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Affiliation(s)
- Jihye Lee
- College of Nursing, The University of Iowa, Iowa City, IA 52242, USA
- The Saban Research Institute, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA
| | - Teresa Marshall
- Preventive and Community Dentistry, The University of Iowa, Iowa City, IA 52242, USA;
| | - Harleah Buck
- College of Nursing, The University of Iowa, Iowa City, IA 52242, USA
| | - Mulder Pamela
- College of Nursing, The University of Iowa, Iowa City, IA 52242, USA
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9
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Qiao C, Zhou J, Wei C, Cao J, Zheng K, Lv M. Cardiac surgery-associated acute kidney injury: a decade of research trends and developments. Front Med (Lausanne) 2025; 12:1572338. [PMID: 40351461 PMCID: PMC12062005 DOI: 10.3389/fmed.2025.1572338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/09/2025] [Indexed: 05/14/2025] Open
Abstract
Background Cardiac surgery-associated acute kidney injury (CSA-AKI) significantly increases postoperative mortality and healthcare costs. Despite the growing volume of CSA-AKI research, the field remains fragmented, with challenges in identifying high-impact studies, collaborative networks, and emerging trends. Bibliometric analysis addresses these gaps by systematically mapping knowledge structures, revealing research priorities, and guiding resource allocation for both researchers and clinicians. Method We analyzed 4,474 CSA-AKI-related publications (2014-2023) from the Web of Science Core Collection (WoSCC) using VOSviewer, CiteSpace, the Bibliometrix Package in R, and the bibliometric online analysis platform. Results Annual publications increased steadily, with the USA and China leading productivity. The Journal of Cardiothoracic and Vascular Anesthesia serves as the foremost preferred journal within this domain. Critical Care (IF = 15.1) has the highest impact factor. Yunjie Li published the most papers. John A Kellum has the highest H-index. The definition, pathogenesis or etiology, diagnosis, prediction, prevention and treatment, which are the research basis in CSA-AKI. Machine learning (ML) and prediction models emerged as dominant frontiers (2021-2023), reflecting a shift toward personalized risk stratification and real-time perioperative decision-making. These advancements align with clinical demands for early AKI detection and precision prevention. Conclusion This study not only maps the evolution of CSA-AKI research but also identifies priority areas for innovation: multicenter validation of predictive models to strengthen generalizability, preventive nephrology frameworks for long-term AKI survivor monitoring, and randomized controlled trials to confirm efficacy of machine learning-based CSA-AKI prediction tools.
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Affiliation(s)
- Changlong Qiao
- Department of Anesthesiology, Shandong Provincial Clinical Research Center for Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Jing Zhou
- Laboratory of Laparoscopic Technology, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Chuansong Wei
- Department of Anesthesiology, Shandong Provincial Clinical Research Center for Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Jing Cao
- Department of Anesthesiology, Shandong Provincial Clinical Research Center for Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, Shandong, China
| | - Ke Zheng
- Graduate School, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Meng Lv
- Department of Anesthesiology, Shandong Provincial Hospital of Shandong First Medical University, Jinan, Shandong, China
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Rivera-Figueroa E, Ansari MAY, Mallory ET, Garg P, Taylor MB, Onder AM. Real-World Testing of a Clinical Strategy to Start Early Peritoneal Dialysis for High-Risk Newborns after Cardiac Surgery. KIDNEY360 2025; 6:531-542. [PMID: 39774669 PMCID: PMC12045514 DOI: 10.34067/kid.0000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 01/03/2025] [Indexed: 01/11/2025]
Abstract
Key Points Inability to achieve negative fluid balance in postoperative 24 hours may be a reliable surrogate marker to start early peritoneal dialysis (PD) after cardiac surgery. Prolonged cardiopulmonary bypass and aorta cross-clamp duration may determine PD catheter placement in the operating room. The first postoperative 8 hours was indiscriminative for the decision to start early PD for these high-risk newborns. Background The beneficial effect of peritoneal dialysis (PD) catheter placement after cardiopulmonary bypass (CPB) in young infants has been demonstrated. However, the indications to start early PD are not agreed upon. Methods This retrospective single-center study was conducted to evaluate the performance of a clinical strategy for early PD start. PD catheters were placed in the operating room after CPB. Those with prolonged CPB times (>180 minutes), postoperative (postop) oligoanuria, and/or inability to achieve negative fluid balance in postop 24 hours were evaluated as high risk and selected for early PD (PD [+]) start. All PD (+) were started within the first postop 24 hours. Primary outcomes were 5% fluid accumulation at postop 48 hours and severe AKI on postop day (POD) 5. Results There were 49 newborns. Twenty-nine newborns were early PD (+) starts, and 20 used the PD catheter as an abdominal drain (PD −). Baseline demographic data were similar. Both groups were oliguric during first postop 8 hours (P = 0.906). The early PD (+) group produced significantly less urine output during POD 1 (0.98 versus 3.02 ml/kg per hour; P = 0.001). At postop 48 hours, the early PD (+) group had a similar prevalence of 5% fluid accumulation as early PD (−): 5 (16.7%) versus 2 (7.41%), respectively (P = 0.427). Severe AKI incidence on POD 5 was similar between the groups (17.3% versus 5.0%; P = 0.204). Time to extubation was longer for the early PD (+) group compared with the PD (−) group: 10.0 days (7.0–16.0) versus 4.0 days (4.0–10.0), respectively (P = 0.017). Conclusions Persistent oliguria and inability to achieve negative fluid balance during initial postop 24 hours may identify those newborns who will benefit from early PD. The first postop 8 hours was indiscriminative for this strategy. PD start may ameliorate the disadvantage for the designated group.
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Affiliation(s)
- Elvia Rivera-Figueroa
- Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, Mississippi
- Division of Pediatric Critical Care, Puerto Rico Women's and Children's Hospital, Ponce Health Sciences University, Bayamon, Puerto Rico
| | - Md Abu Yusuf Ansari
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Padma Garg
- Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, Mississippi
| | - Mary B. Taylor
- Division of Pediatric Critical Care, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, Mississippi
| | - Ali Mirza Onder
- Division of Pediatric Nephrology, Batson Children's Hospital of Mississippi, University of Mississippi, Jackson, Mississippi
- Division of Pediatric Nephrology, Nemours Children's Health, Wilmington, Delaware
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11
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Xu X, Yang R, Yin Y, Zhu Y, Si J, Xu Y. Association of hemoglobin-to-red blood cell distribution width ratio with mortality in critically Ill patients with heart failure and acute kidney injury: insights from the MIMIC-IV database. BMC Cardiovasc Disord 2025; 25:214. [PMID: 40133837 PMCID: PMC11934673 DOI: 10.1186/s12872-025-04632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 03/06/2025] [Indexed: 03/27/2025] Open
Abstract
BACKGROUND The association between the hemoglobin-to-red cell distribution width ratio (HRR) and mortality in critically ill patients with heart failure (HF) and acute kidney injury (AKI) remains uncertain. This research focuses on exploring the association between HRR and both short-term and long-term all-cause mortality in these patients. METHODS Participants were selected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized into tertiles based on HRR values. The primary endpoint was 28-days ICU all-cause mortality. Secondary endpoints included 28-days hospital and 90-days hospital all-cause mortality. Cox proportional hazards models and restricted cubic splines were used to analyze the association between HRR and mortality in patients with HF and AKI. Kaplan-Meier survival analysis estimated endpoint differences across tertiles. RESULTS A total of 7561 patients were included, with 55.5% being male (n=4199). Cox proportional hazards analysis showed a significant link between HRR and both short-term and long-term mortality in critically ill patients with HF and AKI. This association remained significant after adjusting for confounders. The restricted cubic splines model demonstrated a linear relationship between a higher HRR index and a reduced mortality risk. Kaplan-Meier survival analysis revealed significant differences in short-term and long-term mortality among the tertile groups. CONCLUSION The study results show a strong association between lower HRR and increased short-term and long-term mortality in critically ill patients with heart failure and AKI. HRR proves to be a valuable and cost-effective marker for identifying high-risk patients.
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Affiliation(s)
- Xinping Xu
- Laboratory Department, Huai'an No. 3 People'S Hospital, Huaian Second Clinical College of Xuzhou Medical University, Jiangsu, China
| | - Rong Yang
- Laboratory Department, Lianshui People's Hospital of Kangda college, Jiangsu, China
| | - Yujie Yin
- Cardiology, Nanjing Jiangbei Hospital, Affiliated Nanjing Jiangbei Hospital of Xinglin College, Nantong University, 552 Geguan Road, Jiangsu, 210048, China
| | - Yangang Zhu
- Laboratory Department, Lianshui People's Hospital of Kangda college, Jiangsu, China
| | - Jianhong Si
- Blood Transfusion Department, Huai'an TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 3 Heping RoadQing He Distinct, Huai'an, Jiangsu, 223002, China.
| | - Ya Xu
- Cardiology, Nanjing Jiangbei Hospital, Affiliated Nanjing Jiangbei Hospital of Xinglin College, Nantong University, 552 Geguan Road, Jiangsu, 210048, China.
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12
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Gorga SM, Beck T, Chaudhry P, DeFreitas MJ, Fuhrman DY, Joseph C, Krawczeski CD, Kwiatkowski DM, Starr MC, Harer MW, Charlton JR, Askenazi DJ, Selewski DT, Gist KM, Neonatal Kidney Health Consensus Workshop *. Framework for Kidney Health Follow-Up Among Neonates With Critical Cardiac Disease: A Report From the Neonatal Kidney Health Consensus Workshop. J Am Heart Assoc 2025; 14:e040630. [PMID: 40079314 DOI: 10.1161/jaha.124.040630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Collaborators] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2025]
Abstract
Acute kidney injury is common among neonates with critical cardiac disease. Risk factors and associations with kidney-related outcomes are heterogeneous and distinct from other neonates. As survival of children with critical cardiac disease increases to adulthood, the burden of chronic kidney disease is increasing. Thirty percent to 50% of adults with congenital heart disease have impaired kidney function, even in the absence of prior kidney injury episodes. This may be related to the current standardized acute kidney injury criteria, which may not fully capture clinically meaningful kidney injury and long-term kidney health risks. An improved understanding of which neonates with critical cardiac disease should undergo kidney health follow-up is imperative. During the National Institutes of Health-supported Neonatal Kidney Health Consensus Workshop to Address Kidney Health meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on at-risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury, and (3) infants with critical cardiac disease. The critical cardiac disease subgroup, comprising multidisciplinary experts, used a modified Delphi process to achieve consensus on recommendations for kidney health follow-up. In this report, we review available data on kidney health follow-up in critical cardiac disease and summarize the 2 consensus-based recommendations. We introduce novel diagnostic and risk-stratification tools for acute kidney injury diagnosis in neonates with cardiac disease to guide follow-up recommendations. Finally, we identify important knowledge gaps, representing areas of focus for future research. These should be prioritized to understand and improve long-term kidney health in critical cardiac disease.
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Affiliation(s)
- Stephen M Gorga
- University of Michigan Medical School C.S. Mott Children's Hospital Ann Arbor MI USA
| | - Tara Beck
- University of Pittsburgh School of Medicine UPMC Pittsburgh Children's Hospital Pittsburgh PA USA
| | - Paulomi Chaudhry
- Indiana University School of Medicine Riley Hospital for Children Indianapolis IN USA
| | - Marissa J DeFreitas
- University of Miami Miller School of Medicine Holtz Children's Hospital Miami FL USA
| | - Dana Y Fuhrman
- University of Pittsburgh School of Medicine UPMC Pittsburgh Children's Hospital Pittsburgh PA USA
| | - Catherine Joseph
- Baylor College of Medicine Texas Children's Hospital Houston TX USA
| | - Catherine D Krawczeski
- The Ohio State University College of Medicine Nationwide Children's Hospital Columbus OH USA
| | - David M Kwiatkowski
- Stanford University School of Medicine Lucile Packard Children's Hospital Palo Alto CA USA
| | - Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics Indiana University School of Medicine Indianapolis IN USA
- Division of Child Health Service Research, Department of Pediatrics Indiana University School of Medicine Indianapolis IN USA
| | - Matthew W Harer
- Division of Neonatology, Department of Pediatrics University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Jennifer R Charlton
- Division of Pediatric Nephrology, Department of Pediatrics University of Virginia School of Medicine Charlottesville VA USA
| | - David J Askenazi
- Division of Pediatric Nephrology, Department of Pediatrics University of Alabama at Birmingham Birmingham AL USA
| | - David T Selewski
- Division of Pediatric Nephrology, Department of Pediatrics Medical University of South Carolina Charleston SC USA
| | - Katja M Gist
- University of Cincinnati College of Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH USA
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Collaborators
Carolyn L Abotol, Kaashif A Ahmad, O N Ray Bignall, Paige E Condit, Amanda B Deford, Alex Feeney, Matthew C Gillen, Ronnie Guillet, Jaya S Isaac, Caroline V Jackson, Jennifer G Jetton, Marcian A Laster, Kathryn J Lowe, Morgan E Marcuccilli, Kyle A Merrill, Emily A Niemviski, Evelyn Obregon, Erin R Rademacher, Evan A Rajadhyaksha, Kimberly J Reidy, Samantha R Schwartz, Kara C Short, Christine C Stoops, Namrata Todukar, Heidi J Steflik, Namasivavam Ambalavanan, Jennifer L Chmielewski, Mina Hanna, Brianna M Liberio, Shina Menon, Tahagod H Mohamed, Jennifer A Rumple, Keia R Sanderson, Meredith P Schuh, Jeffret L Segar, Cara L Slagle, Danielle E Soranno, Kim T Vuong,
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13
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Shi S, Xiong C, Bie D, Li Y, Wang J. Development and Validation of a Nomogram for Predicting Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery. Pediatr Cardiol 2025; 46:305-311. [PMID: 38217691 DOI: 10.1007/s00246-023-03392-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 01/15/2024]
Abstract
Acute kidney injury (AKI) is a common complication after cardiac surgery and associated with adverse outcomes. The purpose of this study is to construct a nomogram to predict the probability of postoperative AKI in pediatric patients undergoing cardiac surgery. We conducted a single-center retrospective cohort study of 1137 children having cardiac surgery under cardiopulmonary bypass. We randomly divided the included patients into development and validation cohorts at a ratio of 7:3. The least absolute shrinkage and selection operator regression model was used for feature selection. We constructed a multivariable logistic regression model to select predictors and develop a nomogram to predict AKI risk. Discrimination, calibration and clinical benefit of the final prediction model were evaluated in the development and validation cohorts. A simple nomogram was developed to predict risk of postoperative AKI using six predictors including age at operation, cyanosis, CPB duration longer than 120 min, cross-clamp time, baseline albumin and baseline creatinine levels. The area under the receiver operator characteristic curve of the nomogram was 0.739 (95% CI 0.693-0.786) and 0.755 (95% CI 0.694-0.816) for the development and validation cohort, respectively. The calibration curve showed a good correlation between predicted and observed risk of postoperative AKI. Decision curve analysis presented great clinical benefit of the nomogram. This novel nomogram for predicting AKI after pediatric cardiac surgery showed good discrimination, calibration and clinical practicability.
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Affiliation(s)
- Sheng Shi
- Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chao Xiong
- Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongyun Bie
- Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yinan Li
- Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianhui Wang
- Department of Anesthesiology, National Center of Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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14
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Pettit KA, Melink KF, Alten JA, Goldstein SL, Ollberding N, SooHoo M, Sullivan E, Zang H, Stanski NL, Gist KM. Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery. Pediatr Nephrol 2025; 40:523-531. [PMID: 39331076 DOI: 10.1007/s00467-024-06541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/19/2024] [Accepted: 09/11/2024] [Indexed: 09/28/2024]
Abstract
BACKGROUND Pediatric cardiac surgery-associated acute kidney injury (CS-AKI) is common with variable association with outcomes, possibly because transient serum creatinine (SCr) elevations are unrelated to kidney disease. Sub-phenotypes of CS-AKI with biomarker integration may provide prognostic enrichment. This study aims to determine if combining early postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) and SCr into sub-phenotypes strengthens associations with AKI and outcomes. We hypothesized that patients with early subclinical (uNGAL + , SCr -) or damage (uNGAL + , SCr +) CS-AKI would have more postoperative day 2-4 KDIGO-defined AKI and worse clinical outcomes than patients with early functional AKI (uNGAL - , SCr +). METHODS Two-center prospective observational study evaluating combinations of early uNGAL (8-12 h from ICU admission, ≥ 150 ng/mL) and early postoperative (≤ 8 h of admission) KDIGO SCr-defined AKI to predict CS-AKI on postoperative days (POD) 2-4. Four CS-AKI phenotypes were derived (uNGAL - /SCr - ; uNGAL + /SCr - ; uNGAL - /SCr + and uNGAL + /SCr +). The primary outcome was POD2-4 KDIGO SCr-defined CS-AKI. Secondary outcomes included ventilator and intensive care unit-free days (maximum 28). RESULTS Four hundred seventy-six patients (median age 4.8 [IQR 1.4-30.4] months, 39% female) were included. POD2-4 AKI occurred in 44 (9.2%). 27% were uNGAL + /SCr - and 0.4% (n = 2) uNGAL + /SCr + . The adjusted odds of POD2-4 AKI was ninefold higher (aOR: 9.09, 95%CI: 3.84-21.53) in uNGAL + /SCr - when compared to uNGAL - /SCr - . uNGAL + /SCr - was associated with fewer ventilator-free (aOR: 0.30, 95%CI: 0.19-0.48) and ICU-free days (aOR: 0.41, 95%CI: 0.26-0.66) when compared to uNGAL - /SCr - . CONCLUSION Early postoperative uNGAL, regardless of SCr elevation, refines risk assessment for pediatric POD2-4 CS-AKI and associated morbidity, enabling earlier AKI identification and prognostics.
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Affiliation(s)
- Kevin A Pettit
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Katherine F Melink
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jeffrey A Alten
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stuart L Goldstein
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Nicholas Ollberding
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Megan SooHoo
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Emily Sullivan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Huaiyu Zang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Natalja L Stanski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Katja M Gist
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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15
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Luo R, Liu H, Duan X, Hu X, Li X, Zuo Y. Intraoperative dexmedetomidine and acute kidney injury in paediatric noncardiac surgery: a retrospective propensity score-matched analysis. Br J Anaesth 2025; 134:453-460. [PMID: 39668054 DOI: 10.1016/j.bja.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 09/20/2024] [Accepted: 10/14/2024] [Indexed: 12/14/2024] Open
Abstract
BACKGROUND Paediatric acute kidney injury (AKI) is common and linked to longer hospitalisation and mortality. We investigated whether a continuous intraoperative infusion of dexmedetomidine, which increases renal blood flow, was associated with a lower risk of postoperative AKI in paediatric patients undergoing noncardiac surgery. METHODS This retrospective cohort study included paediatric patients undergoing noncardiac surgery between January 2019 and July 2021. Propensity score matching, based on the participants' baseline characteristics, was used to minimise the potential bias. The primary outcome was AKI within 7 days after surgery. The secondary outcomes included ICU admission, in-hospital mortality, length of hospitalisation, intraoperative bradycardia, and hypotension. The exposure of interest was continuous intraoperative infusion of dexmedetomidine at any dosage or duration. Multivariable logistic regression and linear regression analyses were further used to adjust for residual imbalanced intraoperative factors in the matched cohort. RESULTS After propensity score matching, we identified 1858/4091 paediatric patients who had received intraoperative dexmedetomidine infusion. Intraoperative dexmedetomidine infusion was associated with a lower risk of AKI (1.4% vs 3.2%; odds ratio 0.43, 95% confidence interval 0.27-0.66; P<0.001), postoperative ICU admission (odds ratio 0.35, 95% confidence interval 0.30-0.42; P<0.001), and shorter hospitalisation (7 [5-10] vs 9 [6-13] days; P<0.001). Intraoperative bradycardia, hypotension, and in-hospital mortality were similar between the matched groups. CONCLUSIONS This retrospective analysis of a single-centre paediatric noncardiac surgery cohort suggests that intraoperative dexmedetomidine infusion was associated with a lower incidence of AKI within 7 days after surgery. CLINICAL TRIAL REGISTRATION ChiCTR2300069115.
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Affiliation(s)
- Rong Luo
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Haibei Liu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoya Duan
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaojun Hu
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China; Laboratory of Anaesthesia and Critical Care Medicine, National-Local Joint Engineering Research Center of Translational Medicine of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xuehan Li
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yunxia Zuo
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, China.
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16
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Sakura T, Kanazawa T, Shimizu T, Shimizu K, Iwasaki T, Morimatsu H. Association between plasma-free haemoglobin and postoperative acute kidney injury in paediatric cardiac surgery: a prospective observational study. BJA OPEN 2024; 12:100348. [PMID: 39568616 PMCID: PMC11576535 DOI: 10.1016/j.bjao.2024.100348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 08/20/2024] [Indexed: 11/22/2024]
Abstract
Background Acute kidney injury (AKI) is a common complication among patients requiring cardiopulmonary bypass (CPB) during paediatric cardiac surgery. Plasma-free haemoglobin (PFH) produced by haemolysis during CPB contributes to AKI. This study aimed to determine the association between PFH and postoperative AKI during paediatric cardiac surgery requiring CPB. Methods This prospective, single-centre, observational study included children aged <5 yr who underwent cardiac surgery requiring CPB. PFH was measured pre-CPB, every 30 min during CPB, after modified ultrafiltration, on ICU admission, and once a day at 1-3 days after surgery. The study outcome included the relationship between peak PFH concentrations and the development of postoperative AKI up to 3 days after surgery. Additionally, multivariable analysis was performed to determine the risk factors for AKI. Results Of 179 patients, 74 (41%) developed postoperative AKI. Patients who developed AKI had significantly higher peak PFH concentrations (80 mg dl-1 [inter-quartile range, 50-132.5] vs 60 mg dl-1 [40-100]; P=0.006). Multivariable analysis did not identify peak PFH concentrations as an independent risk factor for postoperative AKI (odds ratio [OR] 1.00; 95% confidence interval [CI]: 0.99-1.00; P=0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94-0.99; P=0.007) and CPB duration (OR 1.02; 95% CI: 1.01-1.02; P<0.001). Conclusions There was an association between postoperative AKI and CPB time rather than PFH. Perioperative peak PFH concentrations were significantly higher in patients with postoperative AKI after paediatric cardiac surgery requiring CPB.
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Affiliation(s)
- Takanobu Sakura
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Tomoyuki Kanazawa
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Tatsuhiko Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Kazuyoshi Shimizu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Tatsuo Iwasaki
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama, Japan
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17
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Morgan C, Forest E, Ulrich E, Sutherland S. Pediatric acute kidney injury and adverse health outcomes: using a foundational framework to evaluate a causal link. Pediatr Nephrol 2024; 39:3425-3438. [PMID: 38951220 PMCID: PMC11511696 DOI: 10.1007/s00467-024-06437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 07/03/2024]
Abstract
Acute kidney injury (AKI) is a major global health problem, expensive to manage, and its associations with negative pediatric health outcomes have been clearly demonstrated. One of the most fundamental questions to consider as we use previous epidemiological information to advance research and care paradigms is the strength of the causal link between pediatric AKI and health outcomes. In this review, we apply the foundational framework of the Bradford Hill criteria to evaluate the extent to which a causal link exists between AKI and the associated adverse outcomes in children. Available data in children support a causal link between AKI and short-term outcomes including mortality, length of stay, and ventilation time. Clarifying the causal nature of longer term associations requires further high-quality observational studies in children, careful consideration of what defines the most meaningful and measurable longer term outcomes after pediatric AKI, and integration of evolving biological data related to mechanisms of disease. Preventing or mitigating AKI should lead to improved outcomes. Demonstrating such reversibility will solidify confidence in the causal relationship, improve child health, and highlight an aspect which is highly relevant to clinicians, scientists, and policy makers.
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Affiliation(s)
- Catherine Morgan
- Department of Pediatrics, Division of Nephrology, University of Alberta, Edmonton, AB, Canada.
| | - Emma Forest
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Emma Ulrich
- Department of Pediatrics, Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Scott Sutherland
- Department of Pediatrics, Division of Nephrology, Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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18
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Verma A, Pujara J, Kaul V, Kaushik K, Bajpai S, Makwana B. Perioperative renal oximetry via near-infrared spectroscopy for prediction of acute kidney injury in infants undergoing congenital heart surgery: An observational study. HEART, VESSELS AND TRANSPLANTATION 2024; 0. [DOI: 10.24969/hvt.2024.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2025]
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19
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Kapsner LA, Feißt M, Purbojo A, Prokosch HU, Ganslandt T, Dittrich S, Mang JM, Wällisch W. Using Machine Learning and Feature Importance to Identify Risk Factors for Mortality in Pediatric Heart Surgery. Diagnostics (Basel) 2024; 14:2587. [PMID: 39594254 PMCID: PMC11592497 DOI: 10.3390/diagnostics14222587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Revised: 11/11/2024] [Accepted: 11/13/2024] [Indexed: 11/28/2024] Open
Abstract
Background: The objective of this IRB-approved retrospective monocentric study was to identify risk factors for mortality after surgery for congenital heart defects (CHDs) in pediatric patients using machine learning (ML). CHD belongs to the most common congenital malformations, and remains the leading mortality cause from birth defects. Methods: The most recent available hospital encounter for each patient with an age <18 years hospitalized for CHD-related cardiac surgery between the years 2011 and 2020 was included in this study. The cohort consisted of 1302 eligible patients (mean age [SD]: 402.92 [±562.31] days), who were categorized into four disease groups. A random survival forest (RSF) and the 'eXtreme Gradient Boosting' algorithm (XGB) were applied to model mortality (incidence: 5.6% [n = 73 events]). All models were then applied to predict the outcome in an independent holdout test dataset (40% of the cohort). Results: RSF and XGB achieved average C-indices of 0.85 (±0.01) and 0.79 (±0.03), respectively. Feature importance was assessed with 'SHapley Additive exPlanations' (SHAP) and 'Time-dependent explanations of machine learning survival models' (SurvSHAP(t)), both of which revealed high importance of the maximum values of serum creatinine observed within 72 h post-surgery for both ML methods. Conclusions: ML methods, along with model explainability tools, can reveal interesting insights into mortality risk after surgery for CHD. The proposed analytical workflow can serve as a blueprint for translating the analysis into a federated setting that builds upon the infrastructure of the German Medical Informatics Initiative.
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Affiliation(s)
- Lorenz A. Kapsner
- Medial Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
- Institute of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University of Heidelberg, 69117 Heidelberg, Germany
| | - Ariawan Purbojo
- Department of Paediatric Cardiac Surgery, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Medial Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
| | - Thomas Ganslandt
- Medial Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91058 Erlangen, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
| | - Jonathan M. Mang
- Medical Center for Information and Communication Technology, Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Wolfgang Wällisch
- Department of Pediatric Cardiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany
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20
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Sharma V, Atluri H. Minimizing Acute Kidney Injury in Pediatric Cardiac Surgery: Incidence, Early Detection, and Preemptive Measures. Cureus 2024; 16:e72916. [PMID: 39628731 PMCID: PMC11613292 DOI: 10.7759/cureus.72916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2024] [Accepted: 11/02/2024] [Indexed: 12/06/2024] Open
Abstract
Background Acute kidney injury (AKI) poses a significant challenge in pediatric cardiac surgery, having a profound impact on patient morbidity and mortality. This study aims to determine the incidence of AKI, explore novel biomarkers for early detection, assess potential risk factors along with preemptive strategies to minimize its incidence and compare the results with similar studies that did not use these interventions. Methods This prospective observational cohort study, conducted from October 2022 to June 2024 at a tertiary care center, involved 44 pediatric patients, aged three months to 15 years, undergoing cardiac surgery. Kidney function was assessed through preoperative and postoperative measurements of serum creatinine, urine output, blood urea, and newer biomarkers such as cystatin C and urine neutrophil gelatinase-associated lipocalin (NGAL). AKI was defined and classified using the Acute Kidney Injury Network (AKIN) criteria, based on increases in serum creatinine or reductions in urine output within the first three days post surgery. To reduce the risk of AKI, a low-dose vasopressin infusion and blood transfusion were administered to maintain renal perfusion and optimal hematocrit levels. The incidence of AKI was calculated and compared with other studies that did not utilize these strategies Results AKI occurred in 31.8% (n=14) of the pediatric patients undergoing cardiac surgery. To reduce the risk of AKI, preemptive low-dose vasopressin was used as a preventive strategy. Patients who developed AKI exhibited significant elevations in serum creatinine, blood urea, and cystatin C, with postoperative NGAL levels exceeding 50 ng/ml. The study found a strong correlation between lower intraoperative hematocrit levels (<30%) and a higher incidence of AKI (100% vs. 6.2%, p<0.001). Conclusions Effective management of intraoperative hematocrit levels and the preemptive use of vasopressin are promising strategies for reducing AKI risk by optimizing renal perfusion and function during cardiac surgery. Early detection through biomarkers like cystatin C and NGAL offers the potential for timely intervention and better patient outcomes. These findings contribute to improving risk assessment and perioperative management in pediatric patients vulnerable to AKI.
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Affiliation(s)
- Vipul Sharma
- Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University), Pune, IND
| | - Harika Atluri
- Anaesthesiology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University), Pune, IND
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21
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Mattke AC, Johnson KE, Ariyawansa K, Trnka P, Venugopal PS, Coman D, Schibler A, Gibbons K. Urinary chloride excretion in critical illness and acute kidney injury: a paediatric hypothesis-generating cohort study post cardiopulmonary bypass surgery. Anaesth Intensive Care 2024; 52:397-406. [PMID: 39257339 DOI: 10.1177/0310057x241265119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
Renal chloride metabolism is currently poorly understood but may serve as both a diagnostic and a treatment approach for acute kidney injury. We investigated whether plasma chloride, ammonia and glutamine as well as urinary chloride, ammonium and glutamine concentrations may serve as markers for acute kidney injury in paediatric patients. We conducted a prospective observational trial in a tertiary care paediatric intensive care unit. Ninety-one patients after cardiopulmonary bypass surgery were enrolled. Plasma glutamine, creatinine, (serum) albumin, urinary electrolytes and glutamine were collected pre-cardiopulmonary bypass surgery, at paediatric intensive care unit admission, and at 6, 12, 24, 48 and 72 h after paediatric intensive care unit admission. The urinary strong ion difference was calculated. The median urinary chloride excretion decreased from 51 mmol/L pre-cardiopulmonary bypass to 25 mmol/L at paediatric intensive care unit admission, and increased from 24 h onwards. Patients with acute kidney injury had lower urinary chloride excretion than those without. The median urinary strong ion difference was 59 mmol/L pre-cardiopulmonary bypass, rose to 131 mmol/L at 24 h and fell to 20 mmol/L at 72 h. The plasma chloride rose from 105 mmol/L pre-cardiopulmonary bypass to a maximum of 109 mmol/L at 24 h. At 24 h the plasma chloride concentration was associated with the presence of acute kidney injury. There was no association between plasma or urinary amino acids and chloride excretion or kidney injury. In conclusion, renal chloride excretion decreased in all patients, although this decrease was more pronounced in patients with acute kidney injury. Our findings may reflect a response of the kidneys to critical illness, and acute kidney injury may make these changes more pronounced. Targeting chloride metabolism may offer treatment approaches to acute kidney injury.
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Affiliation(s)
- Adrian C Mattke
- Department of Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
- Paediatric Critical Care Research Group, Brisbane, Australia
- Centre for Children's Health Research, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerry E Johnson
- Department of Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
- Paediatric Critical Care Research Group, Brisbane, Australia
- Centre for Children's Health Research, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Krishanti Ariyawansa
- Department of Paediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
| | - Peter Trnka
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Prem S Venugopal
- Department for Cardiothoracic Surgery, Queensland Children's Hospital, Brisbane, Australia
| | - David Coman
- School of Medicine, The University of Queensland, Brisbane, Australia
- Wesley Research Institute, The Wesley Hospital, Auchenflower, Australia
- Department for Metabolic Medicine, Queensland Children's Hospital, Brisbane, Australia
| | - Andreas Schibler
- Wesley Research Institute, The Wesley Hospital, Auchenflower, Australia
- St Andrew's War Memorial Hospital, Spring Hill, Brisbane, Australia
- Critical Care Research Group, St Andrew's War Memorial Hospital, Brisbane, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
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22
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Joubah MB, Ismail AA, Abdelmohsen G, Alsofyani KA, Yousef AA, Jobah MT, Khawaji A, Abdelmawla M, Sayed MH, Dohain AM. Impact of Blood Sampling Methods on Blood Loss and Transfusion After Pediatric Cardiac Surgery: An Observational Study. J Cardiothorac Vasc Anesth 2024; 38:2002-2008. [PMID: 38918088 DOI: 10.1053/j.jvca.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES The aims of this study were to assess the impact of the closed-loop sampling method on blood loss and the need for blood transfusion in pediatric patients following cardiac surgery. DESIGN Retrospective observational study. SETTING A single tertiary center. PARTICIPANTS All pediatric patients younger than 4 years old who were admitted to the pediatric intensive care unit (PICU) after cardiac surgery were enrolled. The study included 100 pediatric patients in the conservative (postimplementation) group and 43 pediatric patients in the nonconservative group (preimplementation). INTERVENTIONS Observational. MEASUREMENTS The primary outcome was the volume of blood loss during the PICU follow-up period. The secondary outcomes were the requirement for blood transfusion in each group, duration of mechanical ventilation, length of intensive care unit (ICU) stay, length of hospital stay, and mortality. MAIN RESULTS In the conservative (postimplementation) group, blood loss during the follow-up period was 0.67 (0.33-1.16) mL/kg/d, while it was 0.95 (0.50-2.30) mL/kg/d in the nonconservative (preimplementation) group, demonstrating a significant reduction in blood loss in the conservative group (p = 0.012). The groups showed no significant differences in terms of the required blood transfusion volume postoperatively during the first 24 hours, first 48 hours, or after 48 hours (p = 0.061, 0.536, 0.442, respectively). The frequency of blood transfusion was comparable between the groups during the first 24 hours, first 48 hours, or after 48 hours postoperatively (p = 0.277, 0.639, 0.075, respectively). In addition, the groups did not show significant differences in the duration of mechanical ventilation, length of ICU stay, length of hospital stay, or mortality. CONCLUSIONS The closed-loop sampling method can be efficient in decreasing blood loss during postoperative PICU follow-up for pediatric patients after cardiac surgeries. However, its application did not reduce the frequency or the volume of blood transfusion in these patients.
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Affiliation(s)
- Mohammed Bin Joubah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Abdelaziz Ismail
- Department of Anesthesiology, Faculty of Medicine, Cairo University, Cairo, Egypt; Department of Cardiac Anesthesiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Gaser Abdelmohsen
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Khouloud Abdulrhman Alsofyani
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Pediatric Critical Care Unit, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Ali Yousef
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majed Tareq Jobah
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adeeb Khawaji
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohamed Abdelmawla
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Ahmed Mohamed Dohain
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt; Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia.
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23
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Rivetti G, Gizzone P, Petrone D, Di Sessa A, Miraglia del Giudice E, Guarino S, Marzuillo P. Acute Kidney Injury in Children: A Focus for the General Pediatrician. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1004. [PMID: 39201939 PMCID: PMC11352805 DOI: 10.3390/children11081004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024]
Abstract
Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management.
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Affiliation(s)
| | | | | | | | | | | | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi de Crecchio 2, 80138 Naples, Italy; (G.R.); (P.G.); (D.P.); (A.D.S.); (E.M.d.G.); (S.G.)
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24
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Mohrag M, Abdulrasak M, Borik W, Alshamakhi A, Ageeli N, Abu Allah R, Al Hammadah M, Saabi S, Moafa R, Darraj A, Farasani M, Oraibi O, Somaili M, Madkhali MA, Alqassmi S, Someili A. Risk Factors and Outcomes of Acute Kidney Injury After Cardiac Surgery: A Retrospective Observational Single-Center Study. J Clin Med Res 2024; 16:375-380. [PMID: 39206102 PMCID: PMC11349127 DOI: 10.14740/jocmr5220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024] Open
Abstract
Background Acute kidney injury (AKI) following cardiac surgery is a well-described phenomenon, usually associated with hemodynamic changes ultimately leading to ischemic injury to the kidneys. In this study, we assessed the occurrence of AKI in a cohort of patients undergoing elective cardiac surgery at a single center. Methods Patients undergoing elective cardiac surgery (coronary artery bypass grafting (CABG) and/or valve repair) between the years 2016 and 2022 were retrospectively included in the study. Results During the study, 167 patients underwent CABG, valve replacement, or both procedures. The majority were male (85.0%). Post-operative AKI was observed in 27.5% of patients, with 2.4% requiring continuous renal replacement therapy (CRRT)/dialysis. The majority of AKI cases were staged as Kidney Disease: Improving Global Outcomes (KDIGO) stage 1. Among patients needing CRRT/dialysis, 1.8% recovered renal function within 3 months, with 0.6% experiencing 30-day mortality. In univariate analysis, factors associated with AKI included older age (P = 0.003), severe anemia (P < 0.0001), pre-operative creatinine elevation (P < 0.0001), complex surgeries (P < 0.0001), blood product transfusion (P < 0.0001), longer cross-clamp (XC) and cardiopulmonary bypass (CPB) times (P < 0.0001), and inotropes usage (P < 0.0001). Classical risk factors like diabetes mellitus (DM) and hypertension did not show significant differences. The majority of these factors (severe anemia, age, pre-operative creatinine, post-operative inotrope usage, and cross-clamp times) were consistently significant (P < 0.05) in logistic regression analysis. Conclusion Post-operative AKI following cardiac surgery is frequent, with significant associations seen especially with pre-operative anemia. Future investigations focusing on the specific causes of anemia linked to AKI development are essential, considering the high prevalence of hemoglobinopathy traits in our population.
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Affiliation(s)
- Mostafa Mohrag
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed Abdulrasak
- Department of Clinical Sciences, Lund University, Malmo, Sweden
- Department of Gastroenterology and Nutrition, Skane University Hospital, Malmo, Sweden
| | - Waseem Borik
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Nada Ageeli
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Roaa Abu Allah
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Somaya Saabi
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Reema Moafa
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Atheer Darraj
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Omar Oraibi
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed Somaili
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed Ali Madkhali
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Sameer Alqassmi
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Ali Someili
- Department of Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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25
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Thorlacius EM, Keski-Nisula J, Vistnes M, Ojala T, Molin M, Synnergren M, Romlin BS, Ricksten SE, Wåhlander H, Castellheim AG. High-sensitive troponinT, interleukin-8, and interleukin-6 link with post-surgery risk in infant heart surgery. Acta Anaesthesiol Scand 2024; 68:745-752. [PMID: 38531618 DOI: 10.1111/aas.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/19/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This study focuses on biomarkers in infants after open heart surgery, and examines the association of high-sensitive troponin T (hs-cTnT), interleukin-6 (IL-6), and interleukin-8 (IL-8) with postoperative acute kidney injury (AKI), ventilatory support time and need of vasoactive drugs. METHODS Secondary exploratory study from a double-blinded clinical randomized trial (Mile-1) on 70 infants undergoing open heart surgery with cardiopulmonary bypass (CPB). In this sub-study, the entire study population was examined without considering the study drugs. The biomarkers' peak concentration (highest concentration at 2 or 6 h post-CPB) were used for statistical analyses. RESULTS Peak IL-8, hs-cTnT, and IL-6 occurred at 2 h post-CPB for 96%, 79%, and 63% of the patients, respectively. The odds ratio of developing AKI2-3 for IL-6 > 293 pg/mL was 23.4 (95% CI 5.3;104.0), for IL-8 > 100 pg/mL it was 11.5 (3.0;44.2), and for hs-cTnT >5597 pg/mL it was 6.1 (1.5; 24.5). In more than two third of the patients with the highest peak concentrations of IL-8, IL-6, and hs-cTnT, there was a need for ventilatory support for >24 h and use of vasoactive drugs at 24 h post-CPB, while in less than one third of the patients with the lowest peak concentrations of IL-8 and hs-cTnT such requirements were observed. CONCLUSIONS The peak biomarker concentrations and CPB-time strongly predicted AKI2-3, with IL-6 and IL-8 emerging as strongest predictors. Furthermore, our findings suggest that measuring hs-cTnT and IL-8 just 2 h post-CPB-weaning may assist in identifying infants suitable for early extubation and highlight those at risk of prolonged ventilation.
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Affiliation(s)
- Elin M Thorlacius
- Department of Anesthesiology and Intensive Care medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Juho Keski-Nisula
- Department of Anesthesia and Intensive Care, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | - Maria Vistnes
- Department of Internal Medicine, Diakonhjemmet Hospital and Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Tiina Ojala
- Department of Pediatric Cardiology, Children's Hospital, Helsinki University Hospital, Helsinki University, Helsinki, Finland
| | | | - Mats Synnergren
- Department of Pediatric Thoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgitta S Romlin
- Department of Anesthesiology and Intensive Care medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Håkan Wåhlander
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatric Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Albert Gyllencreutz Castellheim
- Department of Anesthesiology and Intensive Care medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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26
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De Souza FM, De Carvalho AV, Ferraz IS, Damiano AP, Brandão MB, Nogueira RJN, De Souza TH. Acute kidney injury in children undergoing cardiac surgery: predictive value of kidney arterial Doppler-based variables. Pediatr Nephrol 2024; 39:2235-2243. [PMID: 38416215 DOI: 10.1007/s00467-024-06319-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/03/2024] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common condition in critically ill children and is associated with increased morbidity and mortality. This study aimed to assess the performance of point-of-care ultrasonography to predict AKI in children undergoing cardiac surgery. METHODS In this prospective study, consecutive children underwent kidney Doppler ultrasound examination within 24 h following cardiac surgery, and an experienced operator obtained both renal resistive index (RRI) and renal pulsatility index (RPI). AKI was defined by the Kidney Disease Improving Global Outcome (KDIGO) criteria. The primary outcome was the diagnosis of severe AKI (KDIGO stage 2 or 3) on day 3. RESULTS A total of 58 patients were included. Median age and weight were 12.9 months (IQR 6.0-37.9) and 7.36 kg (IQR 5.19-11.40), respectively. On day 3, 13 patients were classified as having AKI, of which 11 were severe. RRI could effectively predict AKI (area under the ROC curve [AUC] 0.83, 95% CI 0.71-0.92; p < 0.001) as well as RPI (AUC 0.81, 95% CI 0.69-0.90; p < 0.001). The optimal cutoff value for RRI was 0.85 (sensitivity, 73%; specificity, 83%; positive predictive value [PPV], 50%; and negative predictive value [NPV], 93%), while for RPI was 1.95 (sensitivity, 73%; specificity, 78%; PPV, 44%; and NPV, 92%). Similar results were found in the analysis for prediction on day 5. Significant correlations were found between Doppler-based variables and estimated GFR and furosemide dose on day 3. CONCLUSIONS Kidney Doppler ultrasound may be a promising tool for predicting AKI in children undergoing cardiac surgery.
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Affiliation(s)
- Fabiane M De Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Aline V De Carvalho
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Isabel S Ferraz
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Ana P Damiano
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Marcelo B Brandão
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
| | - Roberto J N Nogueira
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil
- Department of Pediatrics, School of Medicine, São Leopoldo Mandic, Campinas, SP, Brazil
| | - Tiago H De Souza
- Pediatric Intensive Care Unit, Department of Pediatrics, Clinics Hospital of the State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo Street, Campinas, SP, 13083-887, Brazil.
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Huang JB, Lu CC, Wen ZK, Liang SJ. Modifiable risk factors of immediate and long-term outcomes in the operable and inoperable with left-sided infective endocarditis. Heliyon 2024; 10:e32041. [PMID: 38882297 PMCID: PMC11177143 DOI: 10.1016/j.heliyon.2024.e32041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives To evaluate the outcomes of left-sided infective endocarditis that can be operated on and cannot be operated on, and to focus on modifiable risk factors for immediate and long-term mortality. Methods This study retrospectively investigated patients with left-sided infective endocarditis who occurred in our medical center between January 2006 and November 2022. Results 48 in-hospital deaths occurred (5.8 %, 48/832). We identified time from symptoms to admission and symptomatic neurological complications to be risk factors for multiple organ failure upon admission. Time from symptoms to admission and vegetation size in group of isolated medical treatment were significantly shorter than those in the group of heart operation. We also found that preoperative neurological complications, annulus destruction, levels of serum creatinine at 24 and 48 h post heart operation, and perivalvular leakage are risk factors for in-hospital mortality post heart operation. With 148 μmol/L as a cutoff level, the diagnostic sensitivity and specificity of serum creatinine level 48 h post surgery for in-hospital mortality post cardiac surgery are 100 % and 81.6 %, respectively. We found that vegetation size, ICU stay, postoperative serum creatinine at 48 h, left ventricular end diastolic size postoperative, and red blood cell transfusion were associated with all-time mortality. Conclusions Early diagnosis and treatment, improvement of surgical techniques, good protection for heart, kidney and blood and close follow-up are advocated to conduce to better immediate and long-term outcomes of the operable and inoperable with left-sided infective endocarditis.
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Affiliation(s)
- Jing-Bin Huang
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Chang-Chao Lu
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Zhao-Ke Wen
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
| | - Sheng-Jing Liang
- Department of Cardiothoracic Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, and Guangxi Academy of Medical Sciences, 6 Taoyuan Road, Nanning, 530021, Guangxi, China
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Kwiatkowski DM, Alten JA, Mah KE, Selewski DT, Raymond TT, Afonso NS, Blinder JJ, Coghill MT, Cooper DS, Koch JD, Krawczeski CD, Morales DL, Neumayr TM, Rahman AF, Reichle G, Tabbutt S, Webb TN, Borasino S. An evaluation of the outcomes associated with peritoneal catheter use in neonates undergoing cardiac surgery: A multicenter study. JTCVS OPEN 2024; 19:275-295. [PMID: 39015443 PMCID: PMC11247230 DOI: 10.1016/j.xjon.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 07/18/2024]
Abstract
Objective The study objective was to determine if intraoperative peritoneal catheter placement is associated with improved outcomes in neonates undergoing high-risk cardiac surgery with cardiopulmonary bypass. Methods This propensity score-matched retrospective study used data from 22 academic pediatric cardiac intensive care units. Consecutive neonates undergoing Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery category 3 to 5 cardiac surgery with cardiopulmonary bypass at centers participating in the NEonatal and Pediatric Heart Renal Outcomes Network collaborative were studied to determine the association of the use of an intraoperative placed peritoneal catheter for dialysis or passive drainage with clinical outcomes, including the duration of mechanical ventilation. Results Among 1490 eligible neonates in the NEonatal and Pediatric Heart Renal Outcomes Network dataset, a propensity-matched analysis was used to compare 395 patients with peritoneal catheter placement with 628 patients without peritoneal catheter placement. Time to extubation and most clinical outcomes were similar. Postoperative length of stay was 5 days longer in the peritoneal catheter placement cohort (17 vs 22 days, P = .001). There was a 50% higher incidence of moderate to severe acute kidney injury in the no-peritoneal catheter cohort (12% vs 18%, P = .02). Subgroup analyses between specific treatments and in highest risk patients yielded similar associations. Conclusions This study does not demonstrate improved outcomes among neonates with placement of a peritoneal catheter during cardiac surgery. Outcomes were similar apart from longer hospital stay in the peritoneal catheter cohort. The no-peritoneal catheter cohort had a 50% higher incidence of moderate to severe acute kidney injury (12% vs 18%). This analysis does not support indiscriminate peritoneal catheter use, although it may support the utility for postoperative fluid removal among neonates at risk for acute kidney injury. A multicenter controlled trial may better elucidate peritoneal catheter effects.
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Affiliation(s)
- David M. Kwiatkowski
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Jeffrey A. Alten
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Kenneth E. Mah
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - David T. Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Tia T. Raymond
- Department of Pediatrics, Medical City Children’s Hospital, Dallas, Tex
| | | | - Joshua J. Blinder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif
| | - Matthew T. Coghill
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - David S. Cooper
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Joshua D. Koch
- Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, Ariz
| | | | - David L.S. Morales
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tara M. Neumayr
- Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | - A.K.M. Fazlur Rahman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Ala
| | - Garrett Reichle
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, Mich
| | - Sarah Tabbutt
- Department of Pediatrics, University of California – San Francisco School of Medicine, San Francisco, Calif
| | - Tennille N. Webb
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Santiago Borasino
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
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Alghamdi FA, Bin Mahfooz MA, Almutairi HF, Alshaiban NS, Alotibi KE, Kabbani OM, Kabbani MS. Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Neonates Undergoing Open-heart Surgeries: Single Center Experience. J Saudi Heart Assoc 2024; 36:70-78. [PMID: 38919507 PMCID: PMC11195661 DOI: 10.37616/2212-5043.1374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 06/27/2024] Open
Abstract
Background Incidence and outcomes of acute kidney injury (AKI) among neonates who underwent open-heart surgery are not well highlighted in the literature. We aim to assess the incidence, risk factors, and outcome of AKI among neonates undergoing open-heart surgery. Methods This is a retrospective cohort study between 2016 and 2021 for all neonates requiring open heart surgery. The cases were divided into 2 groups: the AKI (index) group and the non-AKI (control) group. The two groups were statistically compared for risk factors, needs for dialysis, and outcomes. Results 100 patients fulfilled the inclusion criteria. Among them, 74 (74%) developed AKI, including 41 (55%), 15 (21%), and 18 (24%) patients in KDIGO stages 1, 2, and 3, respectively. Multivariate analysis comparing both groups demonstrated that low pre-operative creatinine (p = 0.01), prolonged bypass time (p = 0.0004) and high vasoactive inotropic score (VIS), (p = 0.0008) were risk factors for developing AKI post-operatively. Furthermore, in the AKI group, 17 (23%) neonates required renal replacement therapy in the form of peritoneal dialysis. The length of stay was higher in the AKI index group (p = 0.015). Patients who had AKI recovered their kidney function at discharge. There was no difference in mortality between both groups. Conclusion The AKI occurred in 74% of neonates undergoing open-heart surgery, with 23% of them needing peritoneal dialysis. Low pre-operative creatinine, high VIS score, and prolonged bypass time are potential risk factors for AKI development after neonatal open-heart surgery. AKI may lead to prolonged hospitalization, though most affected patients recovered their normal kidney function at discharge.
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Affiliation(s)
- Faisal A. Alghamdi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | | | - Hatim F. Almutairi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Nasser S. Alshaiban
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Khaled E. Alotibi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Omar M. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
| | - Mohamed S. Kabbani
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), Riyadh,
Saudi Arabia
- Department of Cardiac Science, Ministry of National Guard Health Affairs, Riyadh,
Saudi Arabia
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30
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Mohamed TH, Mpody C, Nafiu O. Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes. Am J Perinatol 2024; 41:e2818-e2823. [PMID: 37643826 DOI: 10.1055/a-2161-7663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Perioperative acute kidney injury (AKI) is associated with poor patient outcomes. The epidemiology of perioperative AKI is characterized in children and to a lesser extent in neonates with cardiac disease. We hypothesized that the prevalence of noncardiac perioperative AKI in neonates is higher than in older children. We also hypothesized that certain neonatal characteristics and comorbidities increase the risk of perioperative AKI and hospital mortality. We aimed to characterize the epidemiology and risk factors of perioperative AKI in neonates undergoing noncardiac surgeries and outline the associated mortality risk factors. STUDY DESIGN We performed a retrospective study of neonates ≤28 days old who underwent inpatient noncardiac surgery in 46 U.S. children's hospitals participating in the Pediatric Hospital Information System between 2016 and 2021. AKI was evaluated throughout the surgical admission encounter. AKI was defined using the International Classification of Diseases (ICD) versions 9 and 10 codes. Comorbid risk factors are chronic and longstanding diagnoses and were selected using ICD-9 and ICD-10 diagnostic and procedure codes. RESULTS Perioperative AKI occurred in 10% of neonates undergoing noncardiac surgeries. Comorbidities associated with high risk of perioperative AKI included metabolic, hematologic/immunologic, cardiovascular, and renal disorders. The relative risk of mortality in perioperative AKI was highest in infants with low birthweight (relative risk = 1.49, 1.14-1.94) and those with hematologic (1.46, 1.12-1.90), renal (1.24, 1.01-1.52), and respiratory comorbidities (1.35, 1.09-1.67). CONCLUSION Perioperative AKI is common in neonates undergoing noncardiac surgeries. Infants with high-risk comorbidity profiles for the development of perioperative AKI and mortality may benefit from close surveillance of their kidney function in the perioperative period. Although retrospective, the findings of our study could inform clinicians to tailor neonatal perioperative kidney care to improve short- and long-term outcomes. KEY POINTS · AKI is common in neonates undergoing noncardiac surgeries.. · Extremely preterm and very low birth weight neonates have the highest rates of perioperative AKI.. · Renal, hematologic, and respiratory comorbidities increase mortality risk in neonates with perioperative AKI..
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Affiliation(s)
- Tahagod H Mohamed
- The Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
- The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Christian Mpody
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Olubukola Nafiu
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
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Wilnes B, Castello-Branco B, Branco BC, Sanglard A, Vaz de Castro PAS, Simões-e-Silva AC. Urinary L-FABP as an Early Biomarker for Pediatric Acute Kidney Injury Following Cardiac Surgery with Cardiopulmonary Bypass: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:4912. [PMID: 38732152 PMCID: PMC11084509 DOI: 10.3390/ijms25094912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Acute kidney injury (AKI) following surgery with cardiopulmonary bypass (CPB-AKI) is common in pediatrics. Urinary liver-type fatty acid binding protein (uL-FABP) increases in some kidney diseases and may indicate CPB-AKI earlier than current methods. The aim of this systematic review with meta-analysis was to evaluate the potential role of uL-FABP in the early diagnosis and prediction of CPB-AKI. Databases Pubmed/MEDLINE, Scopus, and Web of Science were searched on 12 November 2023, using the MeSH terms "Children", "CPB", "L-FABP", and "Acute Kidney Injury". Included papers were revised. AUC values from similar studies were pooled by meta-analysis, performed using random- and fixed-effect models, with p < 0.05. Of 508 studies assessed, nine were included, comprising 1658 children, of whom 561 (33.8%) developed CPB-AKI. Significantly higher uL-FABP levels in AKI versus non-AKI patients first manifested at baseline to 6 h post-CPB. At 6 h, uL-FABP correlated with CPB duration (r = 0.498, p = 0.036), postoperative serum creatinine (r = 0.567, p < 0.010), and length of hospital stay (r = 0.722, p < 0.0001). Importantly, uL-FABP at baseline (AUC = 0.77, 95% CI: 0.64-0.89, n = 365), 2 h (AUC = 0.71, 95% CI: 0.52-0.90, n = 509), and 6 h (AUC = 0.76, 95% CI: 0.72-0.80, n = 509) diagnosed CPB-AKI earlier. Hence, higher uL-FABP levels associate with worse clinical parameters and may diagnose and predict CPB-AKI earlier.
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Affiliation(s)
| | | | | | | | | | - Ana Cristina Simões-e-Silva
- Interdisciplinary Laboratory of Medical Investigation, Unit of Pediatric Nephrology, Department of Pediatrics, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte 30130-100, MG, Brazil; (B.W.); (B.C.-B.); (B.C.B.); (A.S.); (P.A.S.V.d.C.)
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Zhang X, Fu J, Feng Z, Li Y, Zhang L, Zhou X, Dai S, Qiu T, Zhou J, Chen S, Ji Y. High Serum Albumin Levels were Associated with Acute Kidney Injury in Pediatric Surgical Intensive Care Units. J Pediatr Surg 2024; 59:621-626. [PMID: 38182536 DOI: 10.1016/j.jpedsurg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 01/07/2024]
Abstract
INTRODUCTION There are limited studies revealing the association between serum albumin concentrations and acute kidney injury (AKI) in critically ill children. METHODS This was a multicenter retrospective study. Children consecutively admitted to four pediatric surgical intensive care units (PSICUs) between January 2016 and December 2020 were screened for analysis. Patients without recorded albumin values during the PSICU stay were excluded. Data were extracted from the electronic medical records systems of the hospitals. AKI was defined according to the Kidney Disease Improving Global Outcome (KDIGO) guidelines. The associations between serum albumin levels and AKI were assessed by using logistic regression models. RESULTS A total of 7802 children were included in the analysis. The median age of the children was 1.0 (interquartile range (IQR), 0.0-4.0) years. There were 3214 (41.2 %) children who developed AKI. In the univariate logistic regression model, serum albumin levels were associated with AKI (odds ratio (OR) = 1.04, 95 % confidence interval (CI) 1.04-1.05). After adjusting for covariates, serum albumin showed an independent association with AKI (OR = 1.04, 95 % CI 1.03-1.05). Albumin levels above 39.43 g/L (OR = 1.036, 95 % CI 1.002-1.070) were associated with AKI in the unadjusted cubic spline. In the adjusted cubic spline, albumin levels above 40.41 g/L (OR = 1.061, 95 % CI 1.003-1.122) were associated with AKI. CONCLUSION High serum albumin was associated with AKI in critically ill children in the PSICU. Further studies are needed to validate our findings. TYPE OF STUDY Prognostic Study. LEVEL OF EVIDENCE LEVEL II.
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Affiliation(s)
- Xuepeng Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jianlei Fu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Zhongxue Feng
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Yang Li
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lifan Zhang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xinyue Zhou
- Department of Pediatric Critical Care Medicine, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu 610041, China
| | - Shiyi Dai
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China; Department of Pediatric Surgery, West China Women's and Children's Hospital, Sichuan University, Chengdu 610041, China
| | - Tong Qiu
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Jiangyuan Zhou
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Siyuan Chen
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China.
| | - Yi Ji
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu 610041, China.
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Nagy M, Onder AM, Rosen D, Mullett C, Morca A, Baloglu O. Predicting pediatric cardiac surgery-associated acute kidney injury using machine learning. Pediatr Nephrol 2024; 39:1263-1270. [PMID: 37934270 DOI: 10.1007/s00467-023-06197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Prediction of cardiac surgery-associated acute kidney injury (CS-AKI) in pediatric patients is crucial to improve outcomes and guide clinical decision-making. This study aimed to develop a supervised machine learning (ML) model for predicting moderate to severe CS-AKI at postoperative day 2 (POD2). METHODS This retrospective cohort study analyzed data from 402 pediatric patients who underwent cardiac surgery at a university-affiliated children's hospital, who were separated into an 80%-20% train-test split. The ML model utilized demographic, preoperative, intraoperative, and POD0 clinical and laboratory data to predict moderate to severe AKI categorized by Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 or 3 at POD2. Input feature importance was assessed by SHapley Additive exPlanations (SHAP) values. Model performance was evaluated using accuracy, area under the receiver operating curve (AUROC), precision, recall, area under the precision-recall curve (AUPRC), F1-score, and Brier score. RESULTS Overall, 13.7% of children in the test set experienced moderate to severe AKI. The ML model achieved promising performance, with accuracy of 0.91 (95% CI: 0.82-1.00), AUROC of 0.88 (95% CI: 0.72-1.00), precision of 0.92 (95% CI: 0.70-1.00), recall of 0.63 (95% CI: 0.32-0.96), AUPRC of 0.81 (95% CI: 0.61-1.00), F1-score of 0.73 (95% CI: 0.46-0.99), and Brier score loss of 0.09 (95% CI: 0.00-0.17). The top ten most important features assessed by SHAP analyses in this model were preoperative serum creatinine, surgery duration, POD0 serum pH, POD0 lactate, cardiopulmonary bypass duration, POD0 vasoactive inotropic score, sex, POD0 hematocrit, preoperative weight, and POD0 serum creatinine. CONCLUSIONS A supervised ML model utilizing demographic, preoperative, intraoperative, and immediate postoperative clinical and laboratory data showed promising performance in predicting moderate to severe CS-AKI at POD2 in pediatric patients.
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Affiliation(s)
- Matthew Nagy
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Ali Mirza Onder
- Division of Pediatric Nephrology, Nemours Children's Hospital, Wilmington, DE, USA
| | - David Rosen
- Division of Pediatric Cardiothoracic Anesthesiology, Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Charles Mullett
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Ayse Morca
- Department of Pediatric Critical Care Medicine and Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Orkun Baloglu
- Department of Pediatric Critical Care Medicine and Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, OH, USA.
- Department of Pediatric Critical Care Medicine and Pediatric Cardiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Ave. M14, Cleveland, OH, 44195, USA.
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Juarez-Villa JD, Zepeda-Quiroz I, Toledo-Ramírez S, Gomez-Johnson VH, Pérez-Allende F, Garibay-Vega BR, Rodríguez Castellanos FE, Moguel-González B, Garcia-Cruz E, Lopez-Gil S. Exploring kidney biopsy findings in congenital heart diseases: Insights beyond cyanotic nephropathy. World J Nephrol 2024; 13:88972. [PMID: 38596269 PMCID: PMC11000040 DOI: 10.5527/wjn.v13.i1.88972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The association between congenital heart disease and chronic kidney disease is well known. Various mechanisms of kidney damage associated with congenital heart disease have been established. The etiology of kidneydisease has commonly been considered to be secondary to focal segmental glomerulosclerosis (FSGS), however, this has only been demonstrated in case reports and not in observational or clinical trials. AIM To identify baseline and clinical characteristics, as well as the findings in kidney biopsies of patients with congenital heart disease in our hospital. METHODS This is a retrospective observational study conducted at the Nephrology Department of the National Institute of Cardiology "Ignacio Chávez". All patients over 16 years old who underwent percutaneous kidney biopsy from January 2000 to January 2023 with congenital heart disease were included in the study. RESULTS Ten patients with congenital heart disease and kidney biopsy were found. The average age was 29.00 years ± 15.87 years with pre-biopsy proteinuria of 6193 mg/24 h ± 6165 mg/24 h. The most common congenital heart disease was Fallot's tetralogy with 2 cases (20%) and ventricular septal defect with 2 (20%) cases. Among the 10 cases, one case of IgA nephropathy and one case of membranoproliferative glomerulonephritis associated with immune complexes were found, receiving specific treatment after histopathological diagnosis, delaying the initiation of kidney replacement therapy. Among remaining 8 cases (80%), one case of FSGS with perihilar variety was found, while the other 7 cases were non-specific FSGS. CONCLUSION Determining the cause of chronic kidney disease can help in delaying the need for kidney replacement therapy. In 2 out of 10 patients in our study, interventions were performed, and initiation of kidney replacement therapy was delayed. Prospective studies are needed to determine the usefulness of kidney biopsy in patients with congenital heart disease.
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Affiliation(s)
- Jose Daniel Juarez-Villa
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Iván Zepeda-Quiroz
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Sebastián Toledo-Ramírez
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Victor Hugo Gomez-Johnson
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Francisco Pérez-Allende
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | | | | | - Bernardo Moguel-González
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Edgar Garcia-Cruz
- Congenital Heart Disease, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
| | - Salvador Lopez-Gil
- Department of Nephrology, Instituto Nacional de Cardiología Ignacio Chavez, Mexico City 14080, Mexico
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Cunningham TW, Bai S, Krawczeski CD, Spencer JD, Phelps C, Yates AR. Acute kidney injury in hypoplastic left heart syndrome patients following the comprehensive stage two palliation. Cardiol Young 2024; 34:552-558. [PMID: 37565360 DOI: 10.1017/s1047951123002974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND An alternative surgical approach for hypoplastic left heart syndrome is the Hybrid pathway, which delays the risk of acute kidney injury outside of the newborn period. We sought to determine the incidence, and associated morbidity, of acute kidney injury after the comprehensive stage 2 and the cumulative incidence after the first two operations in the Hybrid pathway. DESIGN A single centre, retrospective study was conducted of hypoplastic left heart patients completing the second-stage palliation in the Hybrid pathway from 2009 to 2018. Acute kidney injury was defined utilising Kidney Diseases Improving Global Outcomes criteria. Perioperative and post-operative characteristics were analysed. RESULTS Sixty-one patients were included in the study cohort. The incidence of acute kidney injury was 63.9%, with 36.1% developing severe injury. Cumulatively after the Hybrid Stage 1 and comprehensive stage 2 procedures, 69% developed acute kidney injury with 36% developing severe injury. The presence of post-operative acute kidney injury was not associated with an increase in 30-day mortality (acute kidney injury 7.7% versus none 9.1%; p = > 0.9). There was a significantly longer median duration of intubation among those with acute kidney injury (acute kidney injury 32 (8, 155) hours vs. no injury 9 (0, 94) hours; p = 0.018). CONCLUSIONS Acute kidney injury after the comprehensive stage two procedure is common and accounts for most of the kidney injury in the first two operations of the Hybrid pathway. No difference in mortality was detected between those with acute kidney injury and those without, although there may be an increase in morbidity.
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Affiliation(s)
- Tyler W Cunningham
- Department of Pediatrics, Section of Cardiology and Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Shasha Bai
- Pediatric Biostatistics, Emory University, Atlanta, GA, USA
| | | | - John D Spencer
- Section of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Christina Phelps
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Andrew R Yates
- The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
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Thompson EJ, Zimmerman KO, Gonzalez D, Foote HP, Park S, Hill KD, Hurst JH, Hornik CD, Chamberlain RC, Gbadegesin RA, Hornik CP. Population Pharmacokinetics of Caffeine in Neonates with Congenital Heart Disease and Associations with Acute Kidney Injury. J Clin Pharmacol 2024; 64:300-311. [PMID: 37933788 PMCID: PMC10898646 DOI: 10.1002/jcph.2382] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
Cardiac surgery-associated acute kidney injury (CS-AKI) occurs in approximately 65% of neonates undergoing cardiac surgery on cardiopulmonary bypass and contributes to morbidity and mortality. Caffeine may reduce CS-AKI by counteracting adenosine receptor upregulation after bypass, but pharmacokinetics (PK) in this population are unknown. The goal of our analysis is to address knowledge gaps in age-, disease-, and bypass-related effects on caffeine disposition and explore preliminary associations between caffeine exposure and CS-AKI using population PK modeling techniques and an opportunistic, electronic health record-integrated trial design. We prospectively enrolled neonates receiving preoperative caffeine per standard of care and collected PK samples. We retrospectively identified neonates without caffeine exposure undergoing surgery on bypass as a control cohort. We followed US Food and Drug Administration guidance for population PK model development using NONMEM. Effects of clinical covariates on PK parameters were evaluated. We simulated perioperative exposures and used multivariable logistic regression to evaluate the association between caffeine exposure and CS-AKI. Twenty-seven neonates were included in model development. A 1-compartment model with bypass time as a covariate on clearance and volume of distribution best fit the data. Twenty-three neonates with caffeine exposure and 109 controls were included in the exposure-response analysis. Over half of neonates developed CS-AKI. On multivariable analysis, there were no significant differences between CS-AKI with and without caffeine exposure. Neonates with single-ventricle heart disease without CS-AKI had consistently higher simulated caffeine exposures. Our results highlight areas for further study to better understand disease- and bypass-specific effects on drug disposition and identify populations where caffeine may be beneficial.
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Affiliation(s)
- Elizabeth J Thompson
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Henry P Foote
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
| | | | - Kevin D Hill
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
| | - Jillian H Hurst
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
| | - Chi D Hornik
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Christoph P Hornik
- Department of Pediatrics, Duke University Hospital, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Hollander SA, Chung S, Reddy S, Zook N, Yang J, Vella T, Navaratnam M, Price E, Sutherland SM, Algaze CA. Intraoperative and Postoperative Hemodynamic Predictors of Acute Kidney Injury in Pediatric Heart Transplant Recipients. J Pediatr Intensive Care 2024; 13:37-45. [PMID: 38571984 PMCID: PMC10987224 DOI: 10.1055/s-0041-1736336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/28/2021] [Indexed: 10/20/2022] Open
Abstract
Acute kidney injury (AKI) is common after pediatric heart transplantation (HT) and is associated with inferior patient outcomes. Hemodynamic risk factors for pediatric heart transplant recipients who experience AKI are not well described. We performed a retrospective review of 99 pediatric heart transplant patients at Lucile Packard Children's Hospital Stanford from January 1, 2015, to December 31, 2019, in which clinical and demographic characteristics, intraoperative perfusion data, and hemodynamic measurements in the first 48 postoperative hours were analyzed as risk factors for severe AKI (Kidney Disease: Improving Global Outcomes [KDIGO] stage ≥ 2). Univariate analysis was conducted using Fisher's exact test, Chi-square test, and the Wilcoxon rank-sum test, as appropriate. Multivariable analysis was conducted using logistic regression. Thirty-five patients (35%) experienced severe AKI which was associated with lower intraoperative cardiac index ( p = 0.001), higher hematocrit ( p < 0.001), lower body temperature ( p < 0.001), lower renal near-infrared spectroscopy ( p = 0.001), lower postoperative mean arterial blood pressure (MAP: p = 0.001), and higher central venous pressure (CVP; p < 0.001). In multivariable analysis, postoperative CVP >12 mm Hg (odds ratio [OR] = 4.27; 95% confidence interval [CI]: 1.48-12.3, p = 0.007) and MAP <65 mm Hg (OR = 4.9; 95% CI: 1.07-22.5, p = 0.04) were associated with early severe AKI. Children with severe AKI experienced longer ventilator, intensive care, and posttransplant hospital days and inferior survival ( p = 0.01). Lower MAP and higher CVP are associated with severe AKI in pediatric HT recipients. Patients, who experienced AKI, experienced increased intensive care unit (ICU) morbidity and inferior survival. These data may guide the development of perioperative renal protective management strategies to reduce AKI incidence and improve patient outcomes.
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Affiliation(s)
- Seth A. Hollander
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
| | - Sukyung Chung
- Quantitative Sciences Unit, Stanford University, Stanford, California, United States
| | - Sushma Reddy
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
| | - Nina Zook
- Department of Pediatrics, Stanford University, Stanford, California, United States
| | - Jeffrey Yang
- Department of Pediatrics, Stanford University, Stanford, California, United States
| | - Tristan Vella
- Perfusion Services, Lucile Packard Children's Hospital Stanford, Palo Alto, California, United States
| | - Manchula Navaratnam
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California, United States
| | - Elizabeth Price
- Patient Care Services, Cardiovascular Intensive Care Unit, Lucile Packard Children's Hospital Stanford, Palo Alto, California, United States
| | - Scott M. Sutherland
- Department of Pediatrics (Nephrology), Scott M Sutherland, Stanford University School of Medicine, Stanford, California, United States
| | - Claudia A. Algaze
- Department of Pediatrics (Cardiology), Stanford University School of Medicine, Stanford, California, United States
- Center for Pediatric and Maternal Value, Stanford University, Palo Alto, California, Unites States
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Fincher S, Gibbons K, Johnson K, Trnka P, Mattke AC. Urinary Chloride Excretion Postcardiopulmonary Bypass in Pediatric Patients-A Pilot Study. J Pediatr Intensive Care 2024; 13:80-86. [PMID: 38571987 PMCID: PMC10987220 DOI: 10.1055/s-0041-1736549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022] Open
Abstract
The aim of this study was to describe renal chloride metabolism following cardiopulmonary bypass (CPB) surgery in pediatric patients. A prospective observational trial in a tertiary pediatric intensive care unit (PICU) with 20 recruited patients younger than 2 years following CPB surgery was conducted. Urinary electrolytes, plasma urea, electrolytes, creatinine, and arterial blood gases were collected preoperatively, on admission to PICU and at standardized intervals thereafter. The urinary and plasma strong ion differences (SID) were calculated from these results at each time point. Fluid input and output and electrolyte and drug administration were also recorded. Median chloride administration was 67.7 mmol/kg over the first 24 hours. Urinary chloride (mmol/L; median interquartile range [IQR]) was 30 (19, 52) prior to surgery, 15 (15, 65) on admission, and remained below baseline until 24 hours. Plasma chloride (mmol/L; median [IQR]) was 105 (98, 107) prior to surgery and 101 (101, 106) on admission to PICU. It then increased from baseline, but remained within normal limits, for the remainder of the study. The urinary SID increased from 49.8 (19.1, 87.2) preoperatively to a maximum of 122.7 (92.5, 151.8) at 6 hours, and remained elevated until 48 hours. Plasma and urinary chloride concentrations were not associated with the development of acute kidney injury. Urinary chloride excretion is impaired after CPB. The urinary SID increase associated with the decrease in chloride excretion suggests impaired production and/or excretion of ammonium by the nephron following CPB, with gradual recovery postoperatively.
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Affiliation(s)
- Sophie Fincher
- Department of Pediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
- Pediatric Critical Care Research Group, Brisbane, Australia
| | - Kristen Gibbons
- Pediatric Critical Care Research Group, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Kerry Johnson
- Department of Pediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
- Pediatric Critical Care Research Group, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Peter Trnka
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Child and Adolescent Renal Service, Queensland Children's Hospital, Brisbane, Australia
| | - Adrian C. Mattke
- Department of Pediatric Intensive Care, Queensland Children's Hospital, Brisbane, Australia
- Pediatric Critical Care Research Group, Brisbane, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Marosi A, Conway J, Morgan C, Yaskina M, Foshaug R, Chappell A, Ryerson L, Martin BJ, Ash A, Al-Aklabi M, Myers K, Mackie AS. Acute kidney injury and renal recovery following Fontan surgery. JTCVS OPEN 2024; 17:248-256. [PMID: 38420533 PMCID: PMC10897650 DOI: 10.1016/j.xjon.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 03/02/2024]
Abstract
Objectives Acute kidney injury has been described after Fontan surgery, but the duration and outcomes are unknown. We sought to describe the incidence of and risk factors for acute kidney injury and the phenotype of renal recovery, and evaluate the impact of renal recovery phenotype on outcomes. Methods All children who underwent a Fontan operation at a single center between 2009 and 2022 were included. Data collected included Fontan characteristics, vasopressor use, all measures of creatinine, and postoperative outcomes. Logistic regression models were used to assess predictors of acute kidney injury and the association between acute kidney injury and outcomes. Results We enrolled 141 children (45% female). Acute kidney injury occurred in 100 patients (71%). Acute kidney injury duration was transient (<48 hours) in 77 patients (55%), persistent (2-7 days) in 15 patients (11%), more than 7 days in 4 patients (3%), and unknown in 4 patients (3%). Risk factors for acute kidney injury included higher preoperative indexed pulmonary vascular resistance (odds ratio, 3.90; P = .004) and higher postoperative inotrope score on day 0 (odds ratio, 1.13, P = .047). Risk factors for acute kidney injury duration more than 48 hours included absence of a fenestration (odds ratio, 3.43, P = .03) and longer duration of cardiopulmonary bypass (odds ratio, 1.22 per 15-minute interval, P = .01). Acute kidney injury duration more than 48 hours was associated with longer length of stay compared with transient acute kidney injury (median 18 days [interquartile range, 9-62] vs 10 days [interquartile range, 8-16], P = .006) and more sternal wound infections (17% vs 4%, P = .049). Conclusions Acute kidney injury after the Fontan operation is common. The occurrence and duration of acute kidney injury have significant implications for postoperative outcomes.
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Affiliation(s)
- Anna Marosi
- Faculty of Science, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine Morgan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rae Foshaug
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Alyssa Chappell
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsay Ryerson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
| | - Alanna Ash
- Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Mohammed Al-Aklabi
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Kim Myers
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Andrew S Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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40
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Gist KM, Menon S, Anton-Martin P, Bigelow AM, Cortina G, Deep A, De la Mata-Navazo S, Gelbart B, Gorga S, Guzzo I, Mah KE, Ollberding NJ, Shin HS, Thadani S, Uber A, Zang H, Zappitelli M, Selewski DT. Time to Continuous Renal Replacement Therapy Initiation and 90-Day Major Adverse Kidney Events in Children and Young Adults. JAMA Netw Open 2024; 7:e2349871. [PMID: 38165673 PMCID: PMC10762580 DOI: 10.1001/jamanetworkopen.2023.49871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/14/2023] [Indexed: 01/04/2024] Open
Abstract
Importance In clinical trials, the early or accelerated continuous renal replacement therapy (CRRT) initiation strategy among adults with acute kidney injury or volume overload has not demonstrated a survival benefit. Whether the timing of initiation of CRRT is associated with outcomes among children and young adults is unknown. Objective To determine whether timing of CRRT initiation, with and without consideration of volume overload (VO; <10% vs ≥10%), is associated with major adverse kidney events at 90 days (MAKE-90). Design, Setting, and Participants This multinational retrospective cohort study was conducted using data from the Worldwide Exploration of Renal Replacement Outcome Collaborative in Kidney Disease (WE-ROCK) registry from 2015 to 2021. Participants included children and young adults (birth to 25 years) receiving CRRT for acute kidney injury or VO at 32 centers across 7 countries. Statistical analysis was performed from February to July 2023. Exposure The primary exposure was time to CRRT initiation from intensive care unit admission. Main Outcomes and measures The primary outcome was MAKE-90 (death, dialysis dependence, or persistent kidney dysfunction [>25% decline in estimated glomerular filtration rate from baseline]). Results Data from 996 patients were entered into the registry. After exclusions (n = 27), 969 patients (440 [45.4%] female; 16 (1.9%) American Indian or Alaska Native, 40 (4.7%) Asian or Pacific Islander, 127 (14.9%) Black, 652 (76.4%) White, 18 (2.1%) more than 1 race; median [IQR] patient age, 8.8 [1.7-15.0] years) with data for the primary outcome (MAKE-90) were included. Median (IQR) time to CRRT initiation was 2 (1-6) days. MAKE-90 occurred in 630 patients (65.0%), of which 368 (58.4%) died. Among the 601 patients who survived, 262 (43.6%) had persistent kidney dysfunction. Of patients with persistent dysfunction, 91 (34.7%) were dependent on dialysis. Time to CRRT initiation was approximately 1 day longer among those with MAKE-90 (median [IQR], 3 [1-8] days vs 2 [1-4] days; P = .002). In the generalized propensity score-weighted regression, there were approximately 3% higher odds of MAKE-90 for each 1-day delay in CRRT initiation (odds ratio, 1.03 [95% CI, 1.02-1.04]). Conclusions and Relevance In this cohort study of children and young adults receiving CRRT, longer time to CRRT initiation was associated with greater risk of MAKE-90 outcomes, in particular, mortality. These findings suggest that prospective multicenter studies are needed to further delineate the appropriate time to initiate CRRT and the interaction between CRRT initiation timing and VO to continue to improve survival and reduce morbidity in this population.
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Affiliation(s)
- Katja M. Gist
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shina Menon
- Seattle Children’s Hospital, University of Washington, Seattle
| | | | - Amee M. Bigelow
- Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus
| | | | - Akash Deep
- King’s College Hospital, London, England
| | - Sara De la Mata-Navazo
- Gregorio Marañón University Hospital; Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ben Gelbart
- Royal Children’s Hospital, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Stephen Gorga
- University of Michigan Medical School, C.S. Mott Children’s Hospital, Ann Arbor
| | | | - Kenneth E. Mah
- Stanford University School of Medicine, Palo Alto, California
| | - Nicholas J. Ollberding
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Stella Shin
- Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Sameer Thadani
- Baylor College of Medicine, Texas Children’s Hospital, Houston
| | - Amanda Uber
- University of Nebraska Medical Center, Children’s Hospital & Medical Center, Omaha
- University of Utah, Primary Children’s Hospital, Salt Lake City
| | - Huaiyu Zang
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Esmaeili Z, Asgarian F, Aghaei Moghadam E, Khosravi A, Gharib B. Prevalence, risk factors, and outcomes of acute kidney injury in a pediatric cardiac intensive care unit: A cross-sectional study. Health Sci Rep 2024; 7:e1791. [PMID: 38186930 PMCID: PMC10766875 DOI: 10.1002/hsr2.1791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/29/2023] [Accepted: 12/17/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Acute kidney injury (AKI) is a common complication in pediatric cardiac intensive care unit (CICU). This study aims to identify the prevalence, risk factors, and outcomes of AKI in pediatrics admitted to a CICU unit of a tertiary hospital. Methods We retrospectively gathered the data of 253 randomly selected patients admitted to the CICU unit from March 2018 to March 2022. Data were collected from EHRs. We used the Kidney Disease Improving Global Outcomes (KDIGO) criteria for identifying AKI in patients. Results Overall, AKI prevalence was 22.9% in our population. In the multivariable analysis, vancomycin intake (odds ratio [OR]: 2.109, 95% confidence interval [CI]: 1.15-3.84), angiography (OR: 4.38, 95% CI: 1.28-14.93), and mechanical ventilation (OR: 2.08, 95% CI: 1.02-4.23) were independent risk factors of AKI development and patients with AKI had a higher in-hospital mortality rate (OR: 5.81, 95% CI: 2.55-13.19), higher need for cardiopulmonary resuscitation (OR: 3.08, 95% CI: 1.17-8.09), and longer ICU length of stay (OR: 6.49, 95% CI: 3.31-9.67). Furthermore, furosemide administration was associated with lower risk of developing AKI (OR: 0.52, 95% CI: 0.27-0.97). Conclusion AKI is common and is associated with worse outcomes in patients with congenital heart disease. Our results emphasize the importance of early identification and monitoring of AKI in the pediatric CICU setting.
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Affiliation(s)
- Zahra Esmaeili
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Fahimeh Asgarian
- Children's Medical CenterTehran University of Medical SciencesTehranIran
| | | | - Amirali Khosravi
- School of MedicineTehran University of Medical SciencesTehranIran
| | - Behdad Gharib
- Children's Medical CenterTehran University of Medical SciencesTehranIran
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Puzanov A, Tkachuk V, Maksymenko A. Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact - a retrospective single-center study. Ren Fail 2023; 45:2167661. [PMID: 36692196 PMCID: PMC9879166 DOI: 10.1080/0886022x.2023.2167661] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This retrospective study aimed to determine the incidence, risk factors, and outcomes of acute kidney injury (AKI) in neonates following the arterial switch operation (ASO) for transposition of great arteries (TGA). METHODS Retrospective review of medical data of children who underwent ASO in 2019-2020 in the Ukrainian Children's Cardiac Center. RESULTS 76 consecutive neonatal patients were included, 48 developed AKI after ASO (51.7%), and 24 - had severe AKI (25.8%). Severe AKI development was associated with longer cross-clamp time: 82 (61-127) versus 73.5 (53-136) in the non-severe AKI group (p = 0.02). 76 min of cross-clamp time were defined as a threshold value for increased severe AKI risk, OR 4.4 (95% CI: 1.5 - 13, p = 0.01). Higher lactate levels during cardiopulmonary bypass (CPB) increased severe AKI development risk, OR 1.5 (95% CI: 1.0 - 2.0, p = 0.03). Children with severe AKI had prolonged mechanical ventilation, longer time to negative fluid balance, and higher postoperative day 3 (POD3) Inotropic Score (IS). Only one patient required peritoneal dialysis. CONCLUSIONS In our study, 51.7% of patients developed AKI after ASO, 25.8%-severe AKI. Prolonged cross-clamp time and higher lactate levels during cardiopulmonary bypass increased the risk for severe AKI development. The development of AKI was associated with prolonged mechanical ventilation, longer time to negative fluid balance, higher POD 3 Inotropic Score.
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Affiliation(s)
- Anton Puzanov
- Ukrainian Children’s Cardiac Center, Kyiv, Ukraine,CONTACT Anton Puzanov Ukrainian Children’s Cardiac Center, Kyiv, Ukraine
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43
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Sun Y, Zeng X, Shi S, Shi Z, Huang T, Fan Y, Feng Y, Lu X, Duan H, Fan X, Shu Q, Li H. Intraoperative Transfusion of Autologous Blood Protects from Acute Kidney Injury after Pediatric Congenital Heart Surgery. Rev Cardiovasc Med 2023; 24:331. [PMID: 39076442 PMCID: PMC11272828 DOI: 10.31083/j.rcm2411331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/15/2023] [Accepted: 05/24/2023] [Indexed: 07/31/2024] Open
Abstract
Background Acute kidney injury (AKI) is a common complication after pediatric cardiac surgery. And autologous blood transfusion (ABT) is an important predictor of postoperative AKI. Unlike previous studies, which mainly focused on the correlation between ABT and AKI, the current study focuses heavily on the causal relationship between them, thus providing guidance for the treatment of patients during hospitalization to reduce the occurrence of AKI. Methods A retrospective cohort of 3386 patients extracted from the Pediatric Intensive Care database was used for statistical analysis, multifactorial analysis, and causal inference. Characteristics that were correlated with ABT and AKI were categorized as confounders, instrumental variables, and effect modifiers, and were entered into the DoWhy causal inference model to determine causality. The calculated average treatment effect (ATE) was compared with the results of the multifactorial analysis. Results The adjusted odds ratio (OR) for ABT volume was obtained by multifactorial analysis as 0.964. The DoWhy model refute test was able to indicate a causal relationship between ABT and AKI. Any ABT reduces AKI about 15.3%-18.8% by different estimation methods. The ATE regarding the amount of ABT was -0.0088, suggesting that every 1 mL/kg of ABT reduced the risk of AKI by 0.88%. Conclusions Intraoperative transfusion of autologous blood can have a protective effect against postoperative AKI.
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Affiliation(s)
- Yuhan Sun
- Clinical Data Center, Children's Hospital, Zhejiang University School of
Medicine, National Clinical Research Center for Child Health, 310052 Hangzhou,
Zhejiang, China
- The College of Biomedical Engineering and Instrument Science, Zhejiang
University, 310027 Hangzhou, Zhejiang, China
| | - Xian Zeng
- The College of Biomedical Engineering and Instrument Science, Zhejiang
University, 310027 Hangzhou, Zhejiang, China
| | - Shanshan Shi
- CICU, Children's Hospital, Zhejiang University School of Medicine, 310052
Hangzhou, Zhejiang, China
| | - Zhuo Shi
- Cardiac Surgery,Children's Hospital, Zhejiang University School of
Medicine, 310052 Hangzhou, Zhejiang, China
| | - Ting Huang
- Cardiac Surgery,Children's Hospital, Zhejiang University School of
Medicine, 310052 Hangzhou, Zhejiang, China
| | - Yong Fan
- CPB/ECMO Children's Hospital, Zhejiang University School of Medicine,
310052 Hangzhou, Zhejiang, China
| | - Yuqing Feng
- Clinical Data Center, Children's Hospital, Zhejiang University School of
Medicine, National Clinical Research Center for Child Health, 310052 Hangzhou,
Zhejiang, China
| | - Xudong Lu
- The College of Biomedical Engineering and Instrument Science, Zhejiang
University, 310027 Hangzhou, Zhejiang, China
| | - Huilong Duan
- The College of Biomedical Engineering and Instrument Science, Zhejiang
University, 310027 Hangzhou, Zhejiang, China
| | - Xiangming Fan
- Cardiac Surgery,Children's Hospital, Zhejiang University School of
Medicine, 310052 Hangzhou, Zhejiang, China
| | - Qiang Shu
- Cardiac Surgery,Children's Hospital, Zhejiang University School of
Medicine, 310052 Hangzhou, Zhejiang, China
| | - Haomin Li
- Clinical Data Center, Children's Hospital, Zhejiang University School of
Medicine, National Clinical Research Center for Child Health, 310052 Hangzhou,
Zhejiang, China
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Greenberg JW, Hogue S, Raees MA, Ahmed HF, Abplanalp WA, Guzman-Gomez A, Abdelhamed Z, Thangappan K, Reagor JA, Rose JE, Collins M, Kasten JL, Goldstein SL, Zafar F, Morales DLS, Cooper DS. Exogenous nitric oxide delivery protects against cardiopulmonary bypass-associated acute kidney injury: Histologic and serologic evidence from an ovine model. J Thorac Cardiovasc Surg 2023; 166:e164-e173. [PMID: 37164051 DOI: 10.1016/j.jtcvs.2023.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Several human studies have associated nitric oxide administration via the cardiopulmonary bypass circuit with decreased incidence of cardiopulmonary bypass-associated acute kidney injury, but histopathologic and serologic evidence of nitric oxide efficacy for acute kidney injury attenuation are lacking. METHODS By using a survival ovine model (72 hours), acute kidney injury was induced by implementing low-flow cardiopulmonary bypass for 2 hours, followed by full-flow cardiopulmonary bypass for 2 hours. The nitric oxide cohort (n = 6) received exogenous nitric oxide through the cardiopulmonary bypass circuit via the oxygenator, and the control group (n = 5) received no nitric oxide. Serial serologic biomarkers and renal histopathology were obtained. RESULTS Baseline characteristics (age, weight) and intraoperative parameters (cardiopulmonary bypass time, urine output, heart rate, arterial pH, and lactate) were equivalent (P > .10) between groups. Postoperatively, urine output, heart rate, respiratory rate, and peripheral arterial saturation were equivalent (P > .10) between groups. Post-cardiopulmonary bypass creatinine elevations from baseline were significantly greater in the control group versus the nitric oxide group at 16, 24, and 48 hours (all P < .05). Histopathologic evidence of moderate/severe acute kidney injury (epithelial necrosis, tubular slough, cast formation, glomerular edema) occurred in 60% (3/5) of the control group versus 0% (0/6) of the nitric oxide group. Cortical tubular epithelial cilia lengthening (a sensitive sign of cellular injury) was significantly greater in the control group than in the nitric oxide group (P = .012). CONCLUSIONS In a survival ovine cardiopulmonary bypass model, nitric oxide administered with cardiopulmonary bypass demonstrated serologic and histologic evidence of renal protection from acute kidney injury. These results provide insight into 1 potential mechanism for cardiopulmonary bypass-associated acute kidney injury and supports continued study of nitric oxide via cardiopulmonary bypass circuit for prevention of acute kidney injury.
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Affiliation(s)
- Jason W Greenberg
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Spencer Hogue
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Muhammad Aanish Raees
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Hosam F Ahmed
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - William A Abplanalp
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amalia Guzman-Gomez
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Zakia Abdelhamed
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Karthik Thangappan
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James A Reagor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James E Rose
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michaela Collins
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jennifer L Kasten
- Division of Pathology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stuart L Goldstein
- Division of Nephrology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Farhan Zafar
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David L S Morales
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David S Cooper
- The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Raina R, Sethi S, Aitharaju V, Vadhera A, Haq I. Epidemiology data on the cost and outcomes associated with pediatric acute kidney injury. Pediatr Res 2023; 94:1385-1391. [PMID: 36949285 DOI: 10.1038/s41390-023-02564-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/14/2023] [Accepted: 02/21/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Hospitalized children with acute kidney injury (AKI) have not been extensively studied for clinical outcomes including hospital stay, the need for mechanical ventilation, mortality rates, and healthcare utilization. We hypothesize significant financial costs and increased morbidity and mortality associated with pediatric AKI. METHODS This is a retrospective study of pediatric patients (age ≤18 years) included in the Kids' Inpatient Database (KID) between January 1, 2016, and December 31, 2021. The results of the data analysis were utilized for comparative testing between the AKI and non-AKI cohorts. RESULTS The study included 4842 children [with AKI (n = 2424) and without AKI (n = 2418)]. The odds of mortality (p = 0.004) and mechanical ventilation (p < 0.001) were observed to be significantly higher among those with AKI as compared to those without AKI. Additionally, the median (IQR) duration of stay in the hospital (p < 0.001) and total cost (p < 0.001) were significantly higher among those with AKI vs. those without AKI. CONCLUSIONS AKI in children was associated with higher odds of mortality, longer duration of hospital stay, increased requirement of mechanical ventilation, and increased hospital expenditure. The scientific community can utilize this information to better understand the outcomes associated with this disease process in this patient population. IMPACT This article has thoroughly evaluated epidemiologic data associated with pediatric acute kidney injury (AKI) in hospitalized patients This study assesses mortality, hospital expenditure, and other factors to strengthen single-center and few multi-center studies and provides novel data regarding insurance and cost associated with pediatric AKI With increased knowledge of current epidemiology and risk factors, the scientific community can better understand prevention and outcomes in hospitalized children with AKI.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute and Pediatric Intensive Care, Medanta, The Medicity Hospital, Gurgaon, Haryana, 122001, India
| | - Varun Aitharaju
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Imad Haq
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
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Mai DH, Sutherland S, Blinder J, Hollander SA. A novel acute kidney injury scoring system for renal and clinical outcomes in pediatric heart transplant patients. Pediatr Transplant 2023; 27:e14565. [PMID: 37409513 DOI: 10.1111/petr.14565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The development of acute kidney injury (AKI) has been associated with worse outcomes in children after heart transplantation. Our study compares the application of a cumulative six-point Kidney Diseases Improving Global Outcomes (KDIGO) AKI scoring system, utilizing both creatinine and urine output criteria that we term as the AKI-6 criteria, to traditional AKI staging as a predictor for clinical and renal outcomes in the pediatric heart transplant recipients. METHODS We conducted a retrospective single-center chart review on 155 pediatric patients who underwent heart transplantation from May 2014 to December 2021. The primary independent variable was the presence of severe AKI. Severe AKI by KDIGO was defined as Stage ≥2, whereas severe AKI by AKI-6 was defined as cumulative scores ≥4 or Stage 3 AKI based on either KDIGO criterion alone. Primary outcomes included actuarial survival and renal dysfunction by 1-year post-transplant, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 . RESULTS In total, 140 (90%) patients developed AKI; 98 (63%) patients developed severe AKI by KDIGO, and 60 (39%) by AKI-6. Severe AKI by AKI-6 was associated with worse actuarial survival following heart transplantation compared with KDIGO (p = 0.01). Of the 143 patients with 1-year creatinine data, 6 (11%) patients out of 54 with severe AKI by AKI-6 had evidence of renal dysfunction (p = 0.01), compared with 6 (7%) patients out of 88 by KDIGO (p = 0.3). CONCLUSIONS AKI-6 scoring provides greater prognostic utility for actuarial survival and renal dysfunction by 1-year post-heart transplantation in pediatric patients than traditional KDIGO staging.
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Affiliation(s)
- Daniel H Mai
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Scott Sutherland
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Joshua Blinder
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Seth A Hollander
- Stanford University School of Medicine, Palo Alto, California, USA
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Dreher M, Min J, Mavroudis C, Ryba D, Ostapenko S, Melchior R, Rosenthal T, Nuri M, Blinder J. Indexed oxygen delivery during pediatric cardiopulmonary bypass is a modifiable risk factor for postoperative acute kidney injury. THE JOURNAL OF EXTRA-CORPOREAL TECHNOLOGY 2023; 55:112-120. [PMID: 37682209 PMCID: PMC10487348 DOI: 10.1051/ject/2023029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/07/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Acute kidney injury after pediatric cardiac surgery is a common complication with few established modifiable risk factors. We sought to characterize whether indexed oxygen delivery during cardiopulmonary bypass was associated with postoperative acute kidney injury in a large pediatric cohort. METHODS This was a retrospective analysis of patients under 1 year old undergoing cardiac surgery with cardiopulmonary bypass between January 1, 2013, and January 1, 2020. Receiver operating characteristic curves across values ranging from 260 to 400 mL/min/m2 were used to identify the indexed oxygen delivery most significantly associated with acute kidney injury risk. RESULTS We included 980 patients with acute kidney injury occurring in 212 (21.2%). After adjusting for covariates associated with acute kidney injury, an indexed oxygen delivery threshold of 340 mL/min/m2 predicted acute kidney injury in STAT 4 and 5 neonates (area under the curve = 0.66, 95% CI = 0.60 - 0.72, sensitivity = 56.1%, specificity = 69.4%). An indexed oxygen delivery threshold of 400 mL/min/m2 predicted acute kidney injury in STAT 1-3 infants (area under the curve = 0.65, 95% CI = 0.58 - 0.72, sensitivity = 52.6%, specificity = 74.6%). CONCLUSION Indexed oxygen delivery during cardiopulmonary bypass is a modifiable variable independently associated with postoperative acute kidney injury in specific pediatric populations. Strategies aimed at maintaining oxygen delivery greater than 340 mL/min/m2 in complex neonates and greater than 400 mL/min/m2 in infants may reduce the occurrence of postoperative acute kidney injury in the pediatric population.
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Affiliation(s)
- Molly Dreher
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Jungwon Min
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Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Constantine Mavroudis
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Children’s Hospital of Philadelphia, Cardiac Center, Division of Cardiothoracic Surgery Philadelphia PA 19104 USA
| | - Douglas Ryba
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Information Services Department, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Svetlana Ostapenko
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Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Richard Melchior
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Tami Rosenthal
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Department of Cardiovascular Perfusion, Children’s Hospital of Philadelphia Philadelphia PA 19104 USA
| | - Muhammad Nuri
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Children’s Hospital of Philadelphia, Cardiac Center, Division of Cardiothoracic Surgery Philadelphia PA 19104 USA
| | - Joshua Blinder
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Stanford University School of Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology Palo Alto CA 94304 USA
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Stevens H, Gallant J, Foster J, Horne D, Krmpotic K. Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. J Pediatr Intensive Care 2023; 12:167-172. [PMID: 37565014 PMCID: PMC10411109 DOI: 10.1055/s-0041-1730933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/21/2021] [Indexed: 10/21/2022] Open
Abstract
High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.
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Affiliation(s)
- Hannah Stevens
- Faculty of Medicine, Dalhousie University, Halifax, Canada
| | - Julien Gallant
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
| | - Jennifer Foster
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
| | - David Horne
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Division of Pediatric Congenital Cardiac Surgery, IWK Health, Halifax, Canada
- Department of Surgery, Dalhousie University, Halifax, Canada
| | - Kristina Krmpotic
- Faculty of Medicine, Dalhousie University, Halifax, Canada
- Department of Pediatric Critical Care, IWK Health, Halifax, Canada
- Department of Critical Care, Dalhousie University, Halifax, Canada
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49
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Gao P, He W, Jin Y, Zhou C, Zhang P, Wang W, Hu J, Liu J. Acute kidney injury after infant cardiac surgery: a comparison of pRIFLE, KDIGO, and pROCK definitions. BMC Nephrol 2023; 24:251. [PMID: 37612619 PMCID: PMC10464137 DOI: 10.1186/s12882-023-03306-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 08/21/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND KDIGO and pRIFLE classifications are commonly used in pediatric acute kidney injury (AKI). As a novel AKI definition, pROCK considered the high variability of serum creatinine in children. This study aimed to compare the above three definitions for AKI in infants undergoing cardiac surgery. METHODS We analyzed a clinical cohort of 413 infants undergoing cardiac surgery. AKI was defined and staged according to pRIFLE, KDIGO, and pROCK, respectively. Incidence differences and diagnostic agreement across definitions were assessed. The association between postoperative outcomes and AKI by each definition was investigated. RESULTS Postoperative AKI was identified in 185 (44.8%), 160 (38.7%), and 77 (18.6%) patients according to pRIFLE, KDIGO, and pROCK, respectively. The agreement between pRIFLE and KDIGO was almost perfect (κ = 0.88), while there was only a slight agreement between pROCK and them. AKI by pROCK was independently associated with adverse outcomes (p = 0.003) and prolonged mechanical ventilation (p = 0.002). CONCLUSIONS There were considerable differences in AKI incidence and staging among definitions. Compared with pRIFLE and KDIGO, AKI defined by pROCK was significantly reduced and better associated with postoperative adverse outcomes.
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Affiliation(s)
- Peng Gao
- Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wang He
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Yu Jin
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Chun Zhou
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Peiyao Zhang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Wenting Wang
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Jinxiao Hu
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China
| | - Jinping Liu
- Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167, North Lishi Road, Xicheng District, Beijing, China.
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Kumar A, Ghotra GS, Raj S, Tiwari N, Ramamurthy HR. Low-Dose vasopressin and renal perfusion in pediatric cardiac surgery. Ann Card Anaesth 2023; 26:309-317. [PMID: 37470530 PMCID: PMC10451146 DOI: 10.4103/aca.aca_182_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 07/21/2023] Open
Abstract
Background Congenital heart surgeries are associated with post-bypass renal and cardiac dysfunctions. The use of low-dose vasopressin has been found to be beneficial in adult cardiac surgeries. Objective To assess the hemodynamic and renal effects of patients undergoing on-pump pediatric cardiac surgery under general anesthesia (GA) with low-dose vasopressin infusion. Design Prospective randomized controlled study. Setting Operation room and ICU, tertiary care teaching hospital. Patients Fifty-five pediatric cardiac patients undergoing repair for congenital heart diseases (CHD). Interventions Low-dose vasopressin infusion in the study group and placebo in the control group. Measurements and Main Results Renal near-infrared spectroscopy (NIRS), serum NGAL, and inflammatory mediators-IL6 and IL8 along with other renal and hemodynamic parameters in the perioperative period were recorded. Diastolic blood pressure (DBP) and cardiac index were significantly higher in the vasopressin group. Inflammatory markers were significantly high in the immediate postoperative period in all patients which later stabilized in the next 48 h but showed similar trends in both groups. Low-dose vasopressin infusion did not improve either renal perfusion or function. The duration of mechanical ventilation and length of hospital stay, the incidence of AKI development, and transfusion requirements were marginally lower in the vasopressin group, although not significant. Conclusion Low-dose vasopressin infusion improved hemodynamics and showed a decreased incidence of complications. However, it failed to show any benefit of renal function and overall outcome in pediatric cardiac surgery.
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Affiliation(s)
- Alok Kumar
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Gurpinder S. Ghotra
- Department of Anaesthesia and Critical Care, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Sangeeth Raj
- Department of Anaesthesia and Critical Care, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Nikhil Tiwari
- Department of Cardiothoracic Surgery, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - HR Ramamurthy
- Department of Paediatrics, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
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