Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

Jun Sasaki; Zahidee Rodriguez; Jeffrey A Alten; Akm Fazlur Rahman; Garrett Reichle; Paul Lin; Mousumi Banerjee; David Selewski; Michael Gaies; Kristal M Hock; Santiago Borasino; Katja M Gist; NEPHRON Collaborative

doi:10.1016/j.athoracsur.2021.09.032

Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

Ann Thorac Surg. 2022 Nov;114(5):1786-1792. doi: 10.1016/j.athoracsur.2021.09.032. Epub 2021 Oct 20.

Authors

Collaborators

NEPHRON Collaborative:
Parthak Prodhan, Xiomara Garcia, Shannon Ramer, Mindy Sherman, Muhammad B Ghbeis, Shanelle A Clarke, Mary Lukacs, Dominic Zanaboni, Joan Sanchez de Toledo, Yuliya A Domnina, Lucas Saenz, Tracy Baust, Jane Kluck, Linda Duncan, Joshua D Koch, J Wesley Diddle, Joshua Freytag, Amanda Harris, Hideat Abraha, John Butcher, Sachin D Tadphale, Catherine D Krawczeski, David M Kwiatkowski, Tia T Raymond, Grant L Burton, Ashima Das, Tajas Shan, Jason R Buckley, Luke Schroeder, Aanish Raees, Bradley Guidry, Lisa J Sosa, David K Bailly, Kevin M Valentine, Priya N Bhat, Tara M Neumayr, Natasha S Afonso, Erika R O'Neal, Javier J Lasa, Jordan L Huskey, Patrick A Phillips, Amy Ardisana, Kim Gonzalez, Eric Columb, Tammy Domar, Suzanne Viers

Affiliations

¹ Division of Cardiac Critical Care, Department of Cardiology, Nicklaus Children's Hospital, Florida International University Herbert Wertheim College of Medicine, Miami, Florida.
² Divsion of Cardiology, Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia.
³ Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
⁴ Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
⁵ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
⁶ Department of Biostatistics, School of Public Health & Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
⁷ Division of Pediatric Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
⁸ Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.
⁹ Division of Cardiology, Department of Pediatrics, Children's Hospital of Alabama, University of Alabama School of Medicine, Birmingham, Alabama.
¹⁰ Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. Electronic address: gist.kat@gmail.com.

PMID: 34678277
DOI: 10.1016/j.athoracsur.2021.09.032

Abstract

Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery-associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB).

Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay.

Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders.

Conclusions: Kidney Disease: Improving Global Outcomes-defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.

MeSH terms

Acute Kidney Injury* / epidemiology
Acute Kidney Injury* / etiology
Cardiac Surgical Procedures* / adverse effects
Cardiopulmonary Bypass / adverse effects
Child
Creatinine
Humans
Infant, Newborn
Postoperative Complications / etiology
Prostaglandins
Retrospective Studies
Risk Factors

Substances

Creatinine
Prostaglandins