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Cited by 127Acute Kidney Injury ResearchCongenital Heart Disease StudiesCardiac and Coronary Surgery Techniques

Epidemiology of Acute Kidney Injury After Neonatal Cardiac Surgery: A Report From the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network

Alten, Jeffrey A., Cooper, David S., Blinder, Joshua J., Selewski, David T., Tabbutt, Sarah, Sasaki, Jun, Gaies, Michael G., Bertrandt, Rebecca A. +7 more·2021·Critical Care Medicine
DOI 10.1097/ccm.0000000000005165
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Abstract

OBJECTIVES: Cardiac surgery-associated acute kidney injury occurs commonly following congenital heart surgery and is associated with adverse outcomes. This study represents the first multicenter study of neonatal cardiac surgery-associated acute kidney injury. We aimed to describe the epidemiology, including perioperative predictors and associated outcomes of this important complication. DESIGN: This Neonatal and Pediatric Heart and Renal Outcomes Network study is a multicenter, retrospective cohort study of consecutive neonates less than 30 days. Neonatal modification of The Kidney Disease Improving Global Outcomes criteria was used. Associations between cardiac surgery-associated acute kidney injury stage and outcomes (mortality, length of stay, and duration of mechanical ventilation) were assessed through multivariable regression. SETTING: Twenty-two hospitals participating in Pediatric Cardiac Critical Care Consortium. PATIENTS: Twenty-two-thousand forty neonates who underwent major cardiac surgery from September 2015 to January 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Cardiac surgery-associated acute kidney injury occurred in 1,207 patients (53.8%); 983 of 1,657 in cardiopulmonary bypass patients (59.3%) and 224 of 583 in noncardiopulmonary bypass patients (38.4%). Seven-hundred two (31.3%) had maximum stage 1, 302 (13.5%) stage 2, 203 (9.1%) stage 3; prevalence of cardiac surgery-associated acute kidney injury peaked on postoperative day 1. Cardiac surgery-associated acute kidney injury rates varied greatly (27-86%) across institutions. Preoperative enteral feeding (odds ratio = 0.68; 0.52-0.9) and open sternum (odds ratio = 0.76; 0.61-0.96) were associated with less cardiac surgery-associated acute kidney injury; cardiopulmonary bypass was associated with increased cardiac surgery-associated acute kidney injury (odds ratio = 1.53; 1.01-2.32). Duration of cardiopulmonary bypass was not associated with cardiac surgery-associated acute kidney injury in the cardiopulmonary bypass cohort. Stage 3 cardiac surgery-associated acute kidney injury was independently associated with hospital mortality (odds ratio = 2.44; 1.3-4.61). No cardiac surgery-associated acute kidney injury stage was associated with duration of mechanical ventilation or length of stay. CONCLUSIONS: Cardiac surgery-associated acute kidney injury occurs frequently after neonatal cardiac surgery in both cardiopulmonary bypass and noncardiopulmonary bypass patients. Rates vary significantly across hospitals. Only stage 3 cardiac surgery-associated acute kidney injury is associated with mortality. Cardiac surgery-associated acute kidney injury was not associated with any other outcomes. Kidney Disease Improving Global Outcomes criteria may not precisely define a clinically meaningful renal injury phenotype in this population.

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Authors
Alten, J. A., Cooper, D. S., Blinder, J. J., Selewski, D. T., Tabbutt, S., Sasaki, J., Gaies, M. G., Bertrandt, R. A., Smith, A. H., Reichle, G., Gist, K. M., Banerjee, M., Zhang, W., Hock, K. M., & Borasino, S.
Affiliations
  • Cincinnati Children's Hospital Medical Center (US)
  • University of Pennsylvania (US)
  • Medical University of South Carolina (US)
  • University of California, San Francisco (US)
  • Miami Children's Hospital (US)
  • University of Michigan (US)
  • Medical College of Wisconsin (US)
  • Monroe Carell Jr. Children's Hospital (US)
  • Children's Hospital Colorado (US)
  • University of Alabama at Birmingham (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2021-06-24
Volume
49
Issue
10
Pages
e941-e951
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0000000000005165
OpenAlex
W3173565930
Cited by
126
References
41
Citations by year
2026: 22 · 2025: 24 · 2024: 29 · 2023: 26 · 2022: 20 · 2021: 5
FWCI
13.67
Type
journal article
Language
en
Update notices
correction (2022-10-01)
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
  • Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
Keywords
neonatal cardiac surgery, congenital heart disease, cardiopulmonary bypass, AKI risk factors, in-hospital mortality, length of hospital stay, mechanical ventilation duration, AKI staging, pediatric cardiac critical care
MeSH terms
Female, Cardiac Surgical Procedures, Humans, Infant, Newborn, Male, Michigan, Postoperative Complications, Retrospective Studies, Risk Factors, Chi-Square Distribution, Logistic Models, Odds Ratio, Treatment Outcome, Outcome Assessment, Health Care, Acute Kidney Injury

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