Newer insights into acute kidney injury following congenital cardiac surgery using staging criteria & biomarker analysis

ABSTRACT

Acute Kidney Injury (AKI) is a common postoperative complication following congenital heart surgery and is associated with prolonged ventilatory support, prolonged intensive care unit stay, higher morbidity and higher mortality. This study aims to assess the predictive value of AKI staging criteria and biomarkers in children undergoing congenital cardiac surgery.

Keywords

Acute Kidney Injury, congenital heart surgery, biomarkers, staging criteria, pediatric cardiology.

GLOSSARY OF ABBREVIATIONS

• AKI: Acute Kidney Injury
• CRF: Cardiopulmonary Bypass
• GFR: Glomerular Filtration Rate
• KDIGO: Kidney Disease: Improving Global Outcomes
• ICU: Intensive Care Unit
• RACHS: Risk-Adjusted Classification for Congenital Heart Surgery
• RAI: Renal Angina Index

INTRODUCTION

Congenital heart disease is the most common congenital anomaly, occurring with an incidence of 1 in 8 live births, and is the most common cause of newborn death among other birth abnormalities. Acute kidney injury (AKI) is a common complication of congenital cardiac surgery that affects 20–65% of high-risk patients. It is associated with increased morbidity and mortality, prolonged intensive care unit stay, and prolonged hospital stay.

Informed and written consent was obtained from each of the children’s parent/guardian. Subjects were recruited according to the inclusion criteria. A detailed history was followed by a physical examination of the patient. Infants and children who have been diagnosed with acute kidney injury following congenital heart surgery were included in the study.

METHODS

Data was analyzed using Statistical Package of Social Science (SPSS) version 20.0. The study was conducted in a tertiary care hospital over a period of 24 months.

RESULTS

There were 52 patients included in this study, with a mean age of 2.42 ± 2.6 years. 24 (46%) were female children. Common congenital heart defects present in these patients were ventricular septal defect (38.46%), atrial septal defect (12.58%), patent ductus arteriosus (11.54%), tetralogy of Fallot (4.67%), and total anomalous pulmonary venous connection (3.57%).

DISCUSSION

Acute Kidney Injury (AKI) is a common after congenital heart surgery and has an integral correlation with Renal Angina Index (RAI) and Acute Kidney Injury Network (AKIN) criteria. Preoperative creatinine and postoperative cystatin C levels predict AKI following congenital heart surgery.

CONCLUSIONS

Acute kidney injury is common after congenital heart surgery and is a major adverse outcome following congenital heart surgery. Preoperative creatinine level is an independent predictor of AKI after surgery.

REFERENCES

1. Medford, R., Strickland, M., Rible-Coultrup, T. Mild acute kidney injury in pediatric patients after cardiac surgery. J Pediatr. 1998; 205: 807-813.
2. Gili-Ruiz Gili-Espraza MA, Alcaraz Romero AJ, Romero Otero A, Gil Villanueva N, Sanvila Morón E, Rodríguez Sánchez de la Blanca, A. et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol. 2014; 21: 1265-72.