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

Published online by Cambridge University Press:  21 November 2016

David M. Kwiatkowski Open the ORCID record for David M. Kwiatkowski [Opens in a new window] ,
Elizabeth Price ,
David M. Axelrod ,
Anitra W. Romfh ,
Brian S. Han ,
Scott M. Sutherland  and
Catherine D. Krawczeski
David M. Kwiatkowski*
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Elizabeth Price
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
David M. Axelrod
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Anitra W. Romfh
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Brian S. Han
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Scott M. Sutherland
Affiliation:
Division of Nephrology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Catherine D. Krawczeski
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
*
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: [email protected]
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Adult CHDacute kidney injurycardiopulmonary bypasscardiorenal interactions
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1068 - 1075
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Copyright
© Cambridge University Press 2016 

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References

1. Hoffman, JI, Kaplan, S. The incidence of congenital heart disease. J Am Coll Cardiol 2002; 39: 1890–1900.CrossRefGoogle ScholarPubMed
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: 1170–1175.CrossRefGoogle ScholarPubMed
3. Zomer, A, Verheugt, C, Vaartjes, I, et al. Surgery in adults with congenital heart disease. Circulation 2011; 124: 2195–2201.CrossRefGoogle ScholarPubMed
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.Google Scholar
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: 542–546.CrossRefGoogle ScholarPubMed
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: 202–210.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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: 368–374.Google Scholar
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: 195–200.Google Scholar
10. Shaw, A. Update on acute kidney injury after cardiac surgery. J Thorac Cardiovasc 2012; 143: 676–681.CrossRefGoogle ScholarPubMed
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: 110–118.CrossRefGoogle ScholarPubMed
12. Kellum, JA, Lameire, N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17: 204.CrossRefGoogle ScholarPubMed
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: 554–561.Google Scholar
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: 389–396.CrossRefGoogle ScholarPubMed
15. Cockcroft, DW, Gault, MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.Google Scholar
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: 137–147.CrossRefGoogle ScholarPubMed
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: 2320–2328.Google Scholar
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: 165–169.CrossRefGoogle ScholarPubMed
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: 441–447.CrossRefGoogle ScholarPubMed
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: 95–101.Google Scholar
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: 1145–1152.CrossRefGoogle ScholarPubMed
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: 1370–1376.Google Scholar
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: 1939–1943.Google Scholar
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: 299–307.Google ScholarPubMed
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: 885–892.Google Scholar
26. Ronco, C, Haapio, M, House, AA, et al. Cardiorenal syndrome. J Am Coll Cardiol 2008; 52: 1527–1539.CrossRefGoogle ScholarPubMed
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: 408–418.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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: 1752–1761.CrossRefGoogle ScholarPubMed