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Rev Port Cardiol. Revista Portuguesa de Cardiologia English edition. ISSN: Open Access Option. Previous article Next article. Issue 2. Pages February Acute kidney injury after pediatric cardiac surgery: Risk factors and outcomes. Proposal for a predictive model. Download PDF. Corresponding author. This item has received. Under a Creative Commons license. Article information. Table 1. Table 2. Show more Show less. Objectives To characterize the epidemiology and risk factors for acute kidney injury AKI after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population.

Methods This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January and December Exclusion criteria were a history of renal disease, dialysis or renal transplantation.

Alternative sedative reduces the risk of acute kidney injury following cardiac surgery

Results Of the patients included, median age three years 1 day—18 years , AKI occurred in 40 Conclusions AKI is common and is associated with poor short-term outcomes in this setting. The proposed model could be a useful tool for risk stratification of these patients. Acute kidney injury.


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Introduction Congenital heart disease CHD is the most common congenital abnormality and occurs in around 0. The aims of this study were to characterize the epidemiology and risk factors for AKI after pediatric cardiac surgery in our center and to determine its impact on length of mechanical ventilation, length of intensive care unit ICU stay and in-hospital mortality. We also set out to develop a logistic regression model that will predict the risk of AKI in a consistent and objective manner, based on easily obtained clinical and laboratory parameters.

Methods Study design and patient selection This was a single-center, retrospective, observational study based on data collected from the medical records of consecutive pediatric patients who underwent cardiac surgery in our center between January and December Clinical and laboratory variables Preoperative variables were age at time of surgery, gender, weight, height, type of CHD classified as cyanotic or acyanotic , and serum creatinine and blood urea nitrogen on preoperative laboratory testing.

Postoperative GFR was calculated on the basis of serum creatinine levels recorded on the first postoperative day. Urine output was not used as a criterion of renal failure in this cohort, since it is known to be affected by intraoperative and postoperative factors such as diuretic use. Categorical variables are expressed as frequencies and percentages. The Student's t test or the Mann-Whitney test was used in univariate analysis of continuous variables and the chi-square test or Fisher's exact test was used to analyze categorical variables.

The model's goodness of fit was assessed by the Hosmer-Lemeshow test. Results Epidemiology of acute kidney injury after cardiac surgery Of the patients included, median age 3 years 1 day—18 years , 7. Characteristics of children undergoing cardiac surgery according to the occurrence of acute kidney injury. Predictor variables in the logistic regression model. Receiver operating characteristic curve for the proposed logistic regression model.

Figure 1.

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Van der Linde, E. Konings, M. Slager, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. J Am Coll Cardiol, 58 , pp. Li, C. Krawczeski, M. Zappitelli, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med, 39 , pp. Zappitelli, P. Bernier, R. Saczkowski, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery.

Kidney Int, 76 , pp. Mammen, A. Al Abbas, P. Skippen, et al. Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis, 59 , pp. Lacour-Gayet, D. Clarke, J. Jacobs, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg, 25 , pp. Maarslet, M. Dall, et al. Lactate levels predict mortality and need for peritoneal dialysis in children undergoing congenital heart surgery. Acta Anaesthesiol Scand, 56 , pp.

Akcan-Arikan, M. Zappitelli, L. Loftis, et al. Kidney Int, 71 , pp. Ricci, M. Di Nardo, C. Iacoella, et al. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol, 34 , pp. Schwartz, L. Feld, D. A simple estimate of glomerular filtration rate in full-term infants during the first year of life.

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J Pediatr, , pp. Schwartz, B. A simple estimate of glomerular filtration rate in adolescent boys. Park, S. Coca, S. Nigwekar, et al. Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review. Am J Nephrol, 31 , pp. Subscribe to our newsletter. The hybrid approach for palliation of hypoplastic left Clinical and genetic diagnosis of familial hypertrophic Pulmonary arteriovenous malformation closure in a preterm Instructions for authors Submit an article Ethics in publishing.

Article options. Abstract Acute kidney injury AKI is a major medical problem that is of particular concern after cardiac surgery. Keywords: cardiac surgery, acute renal failure, acute kidney injury, prevention, therapy. Introduction Acute kidney injury AKI after cardiac surgery occurs from a rapid deterioration in renal function following cardiac surgery expressed as a significant decrease in glomerular filtration rate GFR.

Defining acute kidney injury More than 30 different definitions for ARF have been used in the past. Table 1 Three criteria for the diagnosis of acute kidney injury. Open in a separate window. Pathogenesis of acute kidney injury after cardiac surgery The pathophysiology of AKI after cardiac surgery is complex and multifactorial. Figure 1. Summary of the different and complex pathophysiologic mechanisms. Risk factors and prediction of acute kidney injury after cardiac surgery A plethora of risk factors have been identified over the last 45 years since the first report of ARF after cardiac surgery.

Prognosis of acute kidney injury after cardiac surgery The long-term consequences of AKI after cardiac surgery might be development of chronic kidney disease, increased mortality, reduced quality of life and increased risk of cardiovascular events. Renal protective strategies Currently, there is no pharmacological intervention that has consistently been associated with renal protection.

Preoperative strategies Delaying elective surgery for renal function optimization in patients with reversible AKI should be considered. Intraoperative strategies Preoperative as well as intraoperative anemia have been shown to be independently associated with AKI after cardiac surgery. Pharmacological renal protection Many drugs aiming for preventing the AKI after cardiac surgery have been studied.

The updated expert opinion of the working group on prevention, AKI section, from the European Society of Intensive Care Medicine, suggests the following recommendations regarding kidney protection during cardiac surgery A summary of all measures for preventing AKI after cardiac surgery can be found in Table 3. Table 3 Summary of all measures that might protect the kidney in cardiac surgery. Conclusion AKI after cardiac surgery is independently associated with a significant increase in morbidity, mortality and health-care costs.

Disclosure The authors report no conflicts of interest in this work.


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Acute kidney injury in major abdominal surgery: incidence, risk factors, pathogenesis and outcomes

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