Risk Factors for Acute Kidney Injury after Congenital Cardiac Surgery in Infants and Children: A Retrospective Observational Study
Open accessAbstract
Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high morbidity and mortality. Modifiable risk factors for postoperative AKI including perioperative anesthesia-related parameters were assessed. The authors conducted a single-center, retrospective cohort study of 220 patients (aged 10 days to 19 years) who underwent congenital cardiac surgery between January and December 2012. The incidence of AKI within 7 days postoperatively was determined using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Ninety-two patients (41.8%) developed AKI and 18 (8.2%) required renal replacement therapy within the first postoperative week. Among patients who developed AKI, 57 patients (25.9%) were KDIGO stage 1, 27 patients (12.3%) were KDIGO stage 2, and eight patients (3.6%) were KDIGO stage 3. RACHS-1 (Risk-Adjusted classification for Congenital Heart Surgery) category, perioperative transfusion and fluid administration as well as fluid overload were compared between patients with and without AKI. Multivariable logistic regression analyses determined the risk factors for AKI. AKI was associated with longer hospital stay or ICU stay, and frequent sternal wound infections. Younger age (<12 months) [odds ratio (OR), 4.01; 95% confidence interval (CI), 1.77-9.06], longer cardiopulmonary bypass (CPB) time (OR, 2.45; 95% CI, 1.24-4.84), and low preoperative hemoglobin (OR, 2.40; 95% CI, 1.07-5.40) were independent risk factors for AKI. Fluid overload was not a significant predictor for AKI. When a variable of hemoglobin concentration increase (>3 g/dl) from preoperative level on POD1 was entered into the multivariable analysis, it was independently associated with postoperative AKI (OR, 6.51; 95% CI, 2.23-19.03 compared with no increase). This association was significant after adjustment with patient demographics, medication history and RACHS-1 category (hemoglobin increase >3g/dl vs. no increase: adjusted OR, 6.94; 95% CI, 2.33-20.69), regardless of different age groups and cyanotic or non-cyanotic heart disease. Prospective trials are required to evaluate whether correction of preoperative anemia and prevention of hemoconcentration may ameliorate postoperative AKI in patients who underwent congenital cardiac surgery.
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Several perioperative factors contribute to cardiac surgery-associated AKI development, including cardiopulmonary bypass, aortic cross-clamping, low cardiac output syndrome, administration of vasoactive agents and albumin, transfusions, inflammation, and clotting abnormalities.
“Several perioperative factors contribute to cardiac surgery-associated AKI development, including cardiopulmonary bypass, aortic cross-clamping, low cardiac output syndrome, administration of vasoactive agents and albumin, transfusions, inflammation, and clotting abnormalities [22].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [22]
The Introduction links longer cardiopulmonary bypass time and vasopressor use to pediatric cardiac surgery-associated AKI. The Results associate transfusion amounts and elevated CRP with AKI, while the Discussion describes low cardiac output and inflammation as possible mechanisms. The paper does not establish aortic cross-clamping, albumin administration, or clotting abnormalities as AKI risk factors; its findings are largely associations rather than proof that these factors contribute causally. (LLM, conf=0.88)
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“Several perioperative factors contribute to cardiac surgery-associated AKI development, including cardiopulmonary bypass, aortic cross-clamping, low cardiac output syndrome, administration of vasoactive agents and albumin, transfusions, inflammation, and clotting abnormalities [22].”
- Authors
- Park, S.-K., Hur, M., Kim, E., Kim, W. H., Park, J. B., Kim, Y., Yang, J.-H., Jun, T.-G., & Kim, C. S.
- Affiliations
- Seoul National University (KR)
- Samsung Medical Center (KR)
- Corresponding author
- Kim, Won Ho
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2016-11-10
- Volume
- 11
- Issue
- 11
- Pages
- e0166328
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5104485
- OpenAlex
- W2556869277
- Cited by
- 133
- References
- 49
- Citations by year
- 2026: 12 · 2025: 13 · 2024: 9 · 2023: 14 · 2022: 14 · 2021: 18 · 2020: 16 · 2019: 14 · 2018: 17 · 2017: 6
- FWCI
- 12.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Seoul National University
- Seoul National University Hospital
- 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
- acute kidney injury, congenital heart surgery, pediatric cardiac surgery, risk factors, cardiopulmonary bypass time, preoperative hemoglobin, hemoglobin increase, fluid overload, perioperative blood transfusion, sternal wound infection, RACHS-1, renal replacement therapy, KDIGO criteria, infants and children, postoperative complications, length of hospital stay, ICU length of stay, age as risk factor
- MeSH terms
- Adolescent, Adult, Cardiopulmonary Bypass, Child, Child, Preschool, Female, Cardiac Surgical Procedures, Humans, Infant, Infant, Newborn, Male, Postoperative Complications, Retrospective Studies, Risk Factors, Incidence, Risk Assessment, Young Adult, Acute Kidney Injury
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