Skip to main content Accessibility help

Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease

  • David M. Kwiatkowski (a1), Elizabeth Price (a1), David M. Axelrod (a1), Anitra W. Romfh (a1), Brian S. Han (a2), Scott M. Sutherland (a3) and Catherine D. Krawczeski (a1)...



Acute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.


This single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.


Data from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.


We demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.


Corresponding author

Correspondence to: D. M. Kwiatkowski, MD, MS, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital Stanford, Suite 325, 750 Welch Road, Palo Alto, CA 94304-5731, United States of America. Tel: +1 650 721 3290; Fax: +1 650 725 8343; E-mail:


Hide All
1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 18901900.
2. Warnes, CA, Liberthson, R, Danielson, GK Jr, et al. Task Force 1: the changing profile of congenital heart disease in adult life. J Am Coll Cardiol 2001; 37: 11701175.
3. Zomer, A, Verheugt, C, Vaartjes, I, et al. Surgery in adults with congenital heart disease. Circulation 2011; 124: 21952201.
4. Englberger, L, Suri, RM, Li, Z, et al. Clinical accuracy of RIFLE and Acute Kidney Injury Network (AKIN) criteria for acute kidney injury in patients undergoing cardiac surgery. Crit Care 2011; 15: R16.
5. Kuitunen, A, Vento, A, Suojaranta-Ylinen, R, et al. Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 2006; 81: 542546.
6. Lex, DJ, Tóth, R, Cserép, Z, et al. A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg 2014; 97: 202210.
7. Li, S, Krawczeski, CD, Zappitelli, M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery – a prospective multicenter study. Crit Care Med 2011; 39: 1493.
8. Blinder, JJ, Goldstein, SL, Lee, V-V, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc 2012; 143: 368374.
9. Loef, BG, Epema, AH, Smilde, TD, et al. Immediate postoperative renal function deterioration in cardiac surgical patients predicts in-hospital mortality and long-term survival. J Am Soc Nephrol 2005; 16: 195200.
10. Shaw, A. Update on acute kidney injury after cardiac surgery. J Thorac Cardiovasc 2012; 143: 676681.
11. Jenkins, KJ, Gauvreau, K, Newburger, JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc 2002; 123: 110118.
12. Kellum, JA, Lameire, N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17: 204.
13. Sutherland, SM, Byrnes, JJ, Kothari, M, et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015; 10: 554561.
14. Bastin, AJ, Ostermann, M, Slack, AJ, et al. Acute kidney injury after cardiac surgery according to risk/injury/failure/loss/end-stage, acute kidney injury network, and Kidney Disease: Improving Global Outcomes classifications. J Crit Care 2013; 28: 389396.
15. Cockcroft, DW, Gault, MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 3141.
16. Levey, AS, Coresh, J, Balk, E, et al. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139: 137147.
17. Dimopoulos, K, Diller, G-P, Koltsida, E, et al. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 2008; 117: 23202328.
18. Buelow, M, Dall, A, Bartz, P, et al. Renal dysfunction is common among adults after palliation for previous tetralogy of Fallot. Pediatr Cardiol 2013; 34: 165169.
19. Buelow, MW, Dall, A, Regner, K, et al. Urinary interleukin-18 and urinary neutrophil gelatinase-associated lipocalin predict acute kidney injury following pulmonary valve replacement prior to serum creatinine. Congenit Heart Dis 2012; 7: 441447.
20. Stellin, G, Vida, V, Padalino, M, et al. Surgical outcome for congenital heart malformations in the adult age: a multicentric European study. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 95101.
21. McIlroy, DR, Argenziano, M, Farkas, D, et al. Incorporating oliguria into the diagnostic criteria for acute kidney injury after on-pump cardiac surgery: impact on incidence and outcomes. J Cardiothorac Vasc Anesth 2013; 27: 11451152.
22. Haase, M, Bellomo, R, Matalanis, G, et al. A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc 2009; 138: 13701376.
23. Robert, AM, Kramer, RS, Dacey, LJ, et al. Cardiac surgery-associated acute kidney injury: a comparison of two consensus criteria. Ann Thorac Surg 2010; 90: 19391943.
24. Machado, MN, Nakazone, MA, Maia, LN. Acute kidney injury based on KDIGO (Kidney Disease Improving Global Outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery. Rev Bras Cir Cardiovasc 2014; 29: 299307.
25. Zappitelli, M, Bernier, P-L, Saczkowski, RS, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009; 76: 885892.
26. Ronco, C, Haapio, M, House, AA, et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 15271539.
27. Park, M, Coca, SG, Nigwekar, SU, et al. Prevention and treatment of acute kidney injury in patients undergoing cardiac surgery: a systematic review. Am J Nephrol 2010; 31: 408418.
28. Macedo, E, Bouchard, J, Soroko, SH, et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care 2010; 14: 1.
29. Haase, M, Devarajan, P, Haase-Fielitz, A, et al. The outcome of neutrophil gelatinase-associated lipocalin-positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol 2011; 57: 17521761.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed