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Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Published online by Cambridge University Press:  20 May 2019

Katja M. Gist ,
Joshua J. Blinder ,
David Bailly ,
Santiago Borasino ,
David J. Askenazi ,
David S. Cooper ,
Catherine D. Krawczeski ,
Michael Gaies ,
David L. S. Morales  and
Kristal M. Hock
...Show all authors
Katja M. Gist*
Affiliation:
Department of Paediatrics, The Heart Institute, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Joshua J. Blinder
Affiliation:
Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
David Bailly
Affiliation:
Division of Critical Care Medicine, Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, UT, USA
Santiago Borasino
Affiliation:
Division of Critical Care Medicine, Department of Paediatrics, Alabama Children’s Hospital, University of Alabama, Birmingham, AL, USA
David J. Askenazi
Affiliation:
Division of Paediatric Nephrology, Department of Paediatrics, Alabama Children’s Hospital, University of Alabama, Birmingham, AL, USA
David S. Cooper
Affiliation:
Department of Paediatrics, University of Cincinnati College of Medicine and Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Catherine D. Krawczeski
Affiliation:
Division of Cardiology, Department of Paediatrics, College of Medicine, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH, USA
Michael Gaies
Affiliation:
Division of Cardiology, Department of Paediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
David L. S. Morales
Affiliation:
Department of Paediatrics Surgery, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Kristal M. Hock
Affiliation:
Division of Critical Care Medicine, Department of Paediatrics, Alabama Children’s Hospital, University of Alabama, Birmingham, AL, USA
Jeffrey Alten
Affiliation:
Department of Paediatrics, University of Cincinnati College of Medicine and Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: Katja M. Gist, University of Colorado Anschutz Medical Campus, Department of Paediatrics, The Heart Institute, Children's Hospital Colorado, 13123 E 16th Ave, B100, Aurora CO 80045, USA. Tel: 720-777-3614; Fax: 720-777-7290; E-mail: [email protected]
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Abstract

Background:

Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.

Methods:

The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.

Results:

A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).

Conclusions:

Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.

Keywords

Neonatal and Paediatricsacute kidney injuryretrospective cohortmethodscardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 4 , April 2019 , pp. 511 - 518
Copyright
© Cambridge University Press 2019 

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Footnotes

*

Both authors contributed equally

References

Ghanayem, NS, Allen, KR, Tabbutt, S, et al. Interstage mortality after the Norwood procedure: results of the multicenter Single Ventricle Reconstruction trial. J Thorac Cardiovasc Surg 2012; 144: 896–906.CrossRefGoogle 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: 446 1980–1992.CrossRefGoogle ScholarPubMed
Butts, RJ, Scheurer, MA, Zyblewski, SC, et al. A composite outcome for neonatal cardiac surgery research. J Thorac Cardiovasc Surg 2014; 147: 449 428–433.CrossRefGoogle ScholarPubMed
Costello, JM, Pasquali, SK, Jacobs, JP, et al. Gestational age at birth and 451 outcomes after neonatal cardiac surgery: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Circulation 2014; 453 129: 2511–2517.CrossRefGoogle Scholar
Agarwal, HS, Wolfram, KB, Saville, BR, Donahue, BS, Bichell, DP. Postoperative complications and association with outcomes in pediatric cardiac surgery. J Thorac Cardiovasc Surg 2014; 148: 609–616 e601.CrossRefGoogle ScholarPubMed
Andropoulos, DB, Ahmad, HB, Haq, T, et al. The association between brain injury, perioperative anesthetic exposure, and 12-month neurodevelop-mental outcomes after neonatal cardiac surgery: a retrospective cohort 460 study. Paediatr Anaesth 2014; 24: 266–274.CrossRefGoogle Scholar
Gaynor, JW, Stopp, C, Wypij, D, et al. Neurodevelopmental outcomes after cardiac surgery in infancy. Pediatrics 2015; 135: 816–825.CrossRefGoogle ScholarPubMed
Mitting, R, Marino, L, Macrae, D, Shastri, N, Meyer, R, Pathan, N. Nutritional 464 status and clinical outcome in postterm neonates undergoing surgery for 465 congenital heart disease. Pediatr Crit Care Med 2015; 16: 448–452.CrossRefGoogle Scholar
Naim, MY, Gaynor, JW, Chen, J, et al. Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery. J Thorac Cardiovasc Surg 2015; 150: 169–178; discussion 178–180.CrossRefGoogle ScholarPubMed
Patel, A, Costello, JM, Backer, CL, et al. Prevalence of noncardiac and genetic abnormalities in neonates undergoing cardiac operations: analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2016; 102: 1607–1614.CrossRefGoogle 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.CrossRefGoogle 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
Piggott, KD, Soni, M, Decampli, WM, et al. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2015; 6: 401–406.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. Criti Care Med 2011; 39: 1493–1499.CrossRefGoogle ScholarPubMed
Li, Y, Wang, J, Bai, Z, et al. Early fluid overload is associated with acute kidney injury and PICU mortality in critically ill children. Eur J Pediatr 2016; 175: 39–48.CrossRefGoogle ScholarPubMed
Watkins, SC, Williamson, K, Davidson, M and Donahue, BS. Long-term mortality associated with acute kidney injury in children following congenital cardiac surgery. Paediatr Anaesth 2014; 24: 919–926.CrossRefGoogle ScholarPubMed
SooHoo, M, Griffin, B, Jovanovich, A, et al. Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review. Pediatr Nephrol 2018; 33: 1235–1242.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
Khwaja, A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120: c179–184.Google ScholarPubMed
Gaies, M, Cooper, DS, Tabbutt, S, et al. Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 2015; 25: 951–957.CrossRefGoogle Scholar
Gaies, M, Donohue, JE, Willis, GM, et al. Data integrity of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Cardiol Young 2016; 26: 1090–1096.CrossRefGoogle ScholarPubMed
Selewski, DT, Charlton, JR, Jetton, JG, et al. Neonatal Acute Kidney Injury. Pediatrics 2015; 136: e463–473.CrossRefGoogle ScholarPubMed
Doi, K, Yuen, PS, Eisner, C, et al. Reduced production of creatinine limits its use as marker of kidney injury in sepsis. J Am Soc Nephrol 2009; 20: 1217–1221.CrossRefGoogle ScholarPubMed
Narayanan, S and Appleton, HD. Creatinine: a review. Clin Chem 1980; 26: 1119–1126.Google ScholarPubMed
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
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 and Investigators, A. Epidemiology of acute kidney injury in critically Ill children and young adults. N Engl J Med 2017; 376: 11–20.CrossRefGoogle ScholarPubMed
Sutherland, SM, Zappitelli, M, Alexander, SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010; 55: 316–325.CrossRefGoogle ScholarPubMed
Hassinger, AB, Wald, EL and Goodman, DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med 2014; 15: 131–138.CrossRefGoogle ScholarPubMed
Seguin, J, Albright, B, Vertullo, L, et al. Extent, risk factors, and outcome of fluid overload after pediatric heart surgery. Crit Care Med 2014; 42: 2591–2599.CrossRefGoogle ScholarPubMed
Hazle, MA, Gajarski, RJ, Yu, S, Donohue, J and Blatt, NB. Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med 2013; 14: 44–49.CrossRefGoogle ScholarPubMed
Arikan, AA, Zappitelli, M, Goldstein, SL, Naipaul, A, Jefferson, LS and Loftis, LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012; 13: 253–258.CrossRefGoogle ScholarPubMed
Wilder, NS, Yu, S, Donohue, JE, Goldberg, CS and Blatt, NB. Fluid overload is associated with late poor outcomes in neonates following cardiac surgery. Pediatr Crit Care Med 2016; 17: 420–427.CrossRefGoogle ScholarPubMed
Sampaio, TZ, O'Hearn, K, Reddy, D and Menon, K. The influence of fluid overload on the length of mechanical ventilation in pediatric congenital heart surgery. Pediatr Cardiol 2015; 36: 1692–1699.CrossRefGoogle ScholarPubMed
Kwiatkowski, DM, Goldstein, SL, Cooper, DS, Nelson, DP, Morales, DL, Krawczeski, CD. Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA Pediatr 2017; 171: 357–364.CrossRefGoogle ScholarPubMed
SooHoo, MM, Patel, SS, Jaggers, J, Faubel, S and 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.CrossRefGoogle ScholarPubMed
Ryerson, LM, Mackie, AS, Atallah, J, et al. Prophylactic peritoneal dialysis catheter does not decrease time to achieve a negative fluid balance after the Norwood procedure: a randomized controlled trial. J Thorac Cardiovasc Surg 2015; 149: 222–228.CrossRefGoogle Scholar
Borasino, S, Wall, KM, Crawford, JH, et al. Furosemide response predicts acute kidney injury after cardiac surgery in infants and neonates. Pediatr Crit Care Med 2018; 19: 310–317.CrossRefGoogle ScholarPubMed
Kakajiwala, A, Kim, JY, Hughes, JZ, et al. Lack of furosemide responsiveness predicts acute kidney injury in infants after cardiac surgery. Ann Thorac Surg 2017; 104: 1388–1394.CrossRefGoogle ScholarPubMed
Cooper, DS, Claes, D, Goldstein, SL, et al. Follow-up renal assessment of injury long-term after acute kidney injury (FRAIL-AKI). Clin J Am Soc Nephrol 2016; 11: 21–29.CrossRefGoogle Scholar
Wong, JH, Selewski, DT, Yu, S, et al. Severe acute kidney injury following stage 1 norwood palliation: effect on outcomes and risk of severe acute kidney injury at subsequent surgical stages. Pediatr Crit Care Med 2016; 17: 615–623.CrossRefGoogle ScholarPubMed
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