Hostname: page-component-76fb5796d-dfsvx Total loading time: 0 Render date: 2024-04-26T08:15:28.474Z Has data issue: false hasContentIssue false
  • English
  • Français

Transient and persistent acute kidney injury phenotypes following the Norwood operation: a retrospective study

Published online by Cambridge University Press:  08 July 2021

Katja M. Gist Open the ORCID record for Katja M. Gist [Opens in a new window] ,
Santiago Borasino ,
Megan SooHoo ,
Danielle E. Soranno ,
Emily Mack ,
Kristal M. Hock Open the ORCID record for Kristal M. Hock [Opens in a new window] ,
A.K.M. Fazlur Rahman ,
John T. Brinton ,
Rajit K. Basu  and
Jeffrey A. Alten
Katja M. Gist*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Santiago Borasino
Affiliation:
Division of Cardiology, Section of Cardiac Critical Care Medicine, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
Megan SooHoo
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Danielle E. Soranno
Affiliation:
Section of Pediatric Nephrology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Emily Mack
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Kristal M. Hock
Affiliation:
Division of Cardiology, Section of Cardiac Critical Care Medicine, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
A.K.M. Fazlur Rahman
Affiliation:
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
John T. Brinton
Affiliation:
Department of Biostatistics and Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Rajit K. Basu
Affiliation:
Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Jeffrey A. Alten
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine;, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: Katja M. Gist, Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, 13123 E 16th Ave, B100, Aurora, CO 80045, USA. Tel: 720-777-3614. E-mail: Katja.gist@childrenscolorado.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes.

Methods:

Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay.

Results:

One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004).

Conclusions:

Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.

Keywords

Acute kidney injuryNorwood operationoutcomesneonataltransientpersistent
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 4 , April 2022 , pp. 564 - 571
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blinder, JJ, Asaro, LA, Wypij, D, et al. Acute kidney injury after pediatric cardiac surgery: a secondary analysis of the safe pediatric euglycemia after cardiac surgery trial. Pediatr Crit Care Med 2017; 18: 638–646.10.1097/PCC.0000000000001185CrossRefGoogle ScholarPubMed
Blinder, JJ, Goldstein, SL, Lee, VV, et al. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012; 143: 368–374.CrossRefGoogle ScholarPubMed
Gist, KM, Blinder, JJ, Bailly, D, et al. Neonatal and paediatric heart and renal outcomes network: design of a multi-centre retrospective cohort study. Cardiol Young 2019; 29: 511–518.CrossRefGoogle ScholarPubMed
Cunningham, TW, Tan, Y, Krawczeski, CD, et al. Incidence and impact of acute kidney injury in patients with hypoplastic left heart syndrome following the hybrid stage 1 palliation. Cardiol Young 2021; 31: 414–420. doi: 10.1017/S1047951120004199 CrossRefGoogle ScholarPubMed
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: 1493–1499.10.1097/CCM.0b013e31821201d3CrossRefGoogle ScholarPubMed
SooHoo, MM, Patel, SS, Jaggers, J, Faubel, S, Gist, KM. Acute kidney injury defined by fluid corrected creatinine in neonates after the Norwood procedure. World J Pediatr Congenit Heart Surg. 2018; 9: 513–521.10.1177/2150135118775413CrossRefGoogle ScholarPubMed
Morgan, CJ, Zappitelli, M, Robertson, CM, et al. Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2013; 162: 120–127 e121.10.1016/j.jpeds.2012.06.054CrossRefGoogle ScholarPubMed
Jetton, JG, Boohaker, LJ, Sethi, SK, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 2017; 1: 184–194.CrossRefGoogle ScholarPubMed
Kaddourah, A, Basu, RK, Bagshaw, SM, Goldstein, SL, Investigators, A. Epidemiology of acute kidney injury in critically Ill children and young adults. N Engl J Med 2017; 376: 11–20.10.1056/NEJMoa1611391CrossRefGoogle ScholarPubMed
Chawla, LS, Bellomo, R, Bihorac, A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 workgroup. Nat Rev Nephrol 2017; 13: 241–257.10.1038/nrneph.2017.2CrossRefGoogle ScholarPubMed
Ohye, RG, Sleeper, LA, Mahony, L, et al. Comparison of shunt types in the Norwood procedure for single-ventricle lesions. N Engl J Med 2010; 362: 1980–1992.10.1056/NEJMoa0912461CrossRefGoogle ScholarPubMed
Garcia, RU, Natarajan, G, Walters, HL, Delius, RE, Aggarwal, S. Acute kidney injury following first-stage palliation in hypoplastic left heart syndrome: hybrid versus Norwood palliation. Cardiol Young 2018; 28: 261–268.CrossRefGoogle ScholarPubMed
Tabbutt, S, Ghanayem, N, Ravishankar, C, et al. Risk factors for hospital morbidity and mortality after the Norwood procedure: a report from the pediatric heart network single ventricle reconstruction trial. J Thorac Cardiovasc Surg 2012; 144: 882–895.10.1016/j.jtcvs.2012.05.019CrossRefGoogle ScholarPubMed
von Elm, E, Altman, DG, Egger, M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 2014; 12: 1495–1499.CrossRefGoogle ScholarPubMed
Sasser, WC, Dabal, RJ, Askenazi, DJ, et al. Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes. Congenit Heart Dis 2014; 9: 106–115.10.1111/chd.12072CrossRefGoogle ScholarPubMed
KDIGO AKI. Work Group: KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2: 1–138.Google Scholar
Zappitelli, M, Ambalavanan, N, Askenazi, DJ, et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 2017; 82: 569–573.CrossRefGoogle ScholarPubMed
Selewski, DT, Charlton, JR, Jetton, JG, et al. Neonatal acute kidney injury. Pediatrics 2015; 136: e463–e473.CrossRefGoogle ScholarPubMed
Gist, KM, Henry, BM, Borasino, S, et al. Prophylactic peritoneal dialysis after the arterial switch operation: a retrospective cohort study. Ann Thorac Surg 2021; 111: 655–661.10.1016/j.athoracsur.2020.04.028CrossRefGoogle ScholarPubMed
Goldstein, SL, Currier, H, Graf, C, Cosio, CC, Brewer, ED, Sachdeva, R. Outcome in children receiving continuous venovenous hemofiltration. Pediatrics 2001; 107: 1309–1312.10.1542/peds.107.6.1309CrossRefGoogle ScholarPubMed
Mehta, S, Chauhan, K, Patel, A, et al. The prognostic importance of duration of AKI: a systematic review and meta-analysis. BMC Nephrol 2018; 19: 91.CrossRefGoogle ScholarPubMed
Krawczeski, CD, Goldstein, SL, Woo, JG, et al. Temporal relationship and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 2011; 58: 2301–2309.10.1016/j.jacc.2011.08.017CrossRefGoogle ScholarPubMed
Bojan, M, Lopez-Lopez, V, Pouard, P, Falissard, B, Journois, D. Limitations of early serum creatinine variations for the assessment of kidney injury in neonates and infants with cardiac surgery. PLoS One 2013; 8: e79308.CrossRefGoogle ScholarPubMed
Tabbutt, S, Schuette, J, Zhang, W, et al. A novel model demonstrates variation in risk-adjusted mortality across pediatric cardiac ICUs after surgery. Pediatr Crit Care Med 2019; 20: 136–142.CrossRefGoogle ScholarPubMed
Basu, RK, Wong, HR, Krawczeski, CD, et al. Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol 2014; 64: 2753–2762.CrossRefGoogle ScholarPubMed
McMahon, BA, Galligan, M, Redahan, L, et al. Biomarker predictors of adverse acute kidney injury outcomes in critically ill patients: the Dublin acute biomarker group evaluation study. Am J Nephrol 2019; 50: 19–28.10.1159/000500231CrossRefGoogle ScholarPubMed
Supplementary material: File

Gist et al. supplementary material

Tables S1 and S2

Download Gist et al. supplementary material(File)
File 26.8 KB