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Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates

Published online by Cambridge University Press:  08 November 2013

J. Bryan Carmody*
Affiliation:
Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia, United States of America
Michael D. Seckeler
Affiliation:
Section of Pediatric Cardiology, University of Arizona College of Medicine, Tucson, Arizona, United States of America
Cortney R. Ballengee
Affiliation:
Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
Mark Conaway
Affiliation:
Department of Biostatistics and Epidemiology, University of Virginia, Charlottesville, Virginia, United States of America
K. Anitha Jayakumar
Affiliation:
Sanger Heart and Vascular Institute and Levine Children's Hospital, Charlotte, North Carolina, United States of America
Jennifer R. Charlton
Affiliation:
Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, Virginia, United States of America
*
Correspondence to: J. B. Carmody, MD, MPH, 601 Children's Lane, Norfolk, VA 23507, United States of America. (757) 668-7244; Fax: (757) 668-9814; E-mail: James.Carmody@chkd.org

Abstract

Objective: Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. Design/Setting: We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Results: Using a linear change point model, a threshold renal volume of 17 cm3 was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm3 (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Conclusions: Pre-operative renal volume ≤17 cm3 is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2013 

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