Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

NEPHRON Collaborative

doi:10.1016/j.athoracsur.2021.09.032

Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

NEPHRON Collaborative

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

Abstract

Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery–associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB). Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay. Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders. Conclusions: Kidney Disease: Improving Global Outcomes–defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.

Original language	English
Pages (from-to)	1786-1792
Number of pages	7
Journal	Annals of Thoracic Surgery
Volume	114
Issue number	5
DOIs	https://doi.org/10.1016/j.athoracsur.2021.09.032
State	Published - Nov 2022

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10.1016/j.athoracsur.2021.09.032

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@article{4141e22c84564e4cb41a7cf01e2aaf3c,

title = "Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass",

abstract = "Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery–associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB). Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay. Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders. Conclusions: Kidney Disease: Improving Global Outcomes–defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.",

author = "{NEPHRON Collaborative} and Jun Sasaki and Zahidee Rodriguez and Alten, {Jeffrey A.} and Rahman, {AKM Fazlur} and Garrett Reichle and Paul Lin and Mousumi Banerjee and David Selewski and Michael Gaies and Hock, {Kristal M.} and Santiago Borasino and Gist, {Katja M.} and Parthak Prodhan and Xiomara Garcia and Shannon Ramer and Mindy Sherman and Ghbeis, {Muhammad B.} and Clarke, {Shanelle A.} and Mary Lukacs and Dominic Zanaboni and {Sanchez de Toledo}, Joan and Domnina, {Yuliya A.} and Lucas Saenz and Tracy Baust and Jane Kluck and Linda Duncan and Koch, {Joshua D.} and Diddle, {J. Wesley} and Joshua Freytag and Amanda Harris and Hideat Abraha and John Butcher and Tadphale, {Sachin D.} and Krawczeski, {Catherine D.} and Kwiatkowski, {David M.} and Raymond, {Tia T.} and Burton, {Grant L.} and Ashima Das and Tajas Shan and Buckley, {Jason R.} and Luke Schroeder and Aanish Raees and Bradley Guidry and Sosa, {Lisa J.} and Bailly, {David K.} and Valentine, {Kevin M.} and Bhat, {Priya N.} and Neumayr, {Tara M.} and Afonso, {Natasha S.} and O'Neal, {Erika R.} and Lasa, {Javier J.} and Huskey, {Jordan L.} and Phillips, {Patrick A.} and Amy Ardisana and Kim Gonzalez and Eric Columb and Tammy Domar and Suzanne Viers",

note = "Publisher Copyright: {\textcopyright} 2022 The Society of Thoracic Surgeons",

year = "2022",

month = nov,

doi = "10.1016/j.athoracsur.2021.09.032",

language = "English",

volume = "114",

pages = "1786--1792",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

number = "5",

}

TY - JOUR

T1 - Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

AU - NEPHRON Collaborative

AU - Sasaki, Jun

AU - Rodriguez, Zahidee

AU - Alten, Jeffrey A.

AU - Rahman, AKM Fazlur

AU - Reichle, Garrett

AU - Lin, Paul

AU - Banerjee, Mousumi

AU - Selewski, David

AU - Gaies, Michael

AU - Hock, Kristal M.

AU - Borasino, Santiago

AU - Gist, Katja M.

AU - Prodhan, Parthak

AU - Garcia, Xiomara

AU - Ramer, Shannon

AU - Sherman, Mindy

AU - Ghbeis, Muhammad B.

AU - Clarke, Shanelle A.

AU - Lukacs, Mary

AU - Zanaboni, Dominic

AU - Sanchez de Toledo, Joan

AU - Domnina, Yuliya A.

AU - Saenz, Lucas

AU - Baust, Tracy

AU - Kluck, Jane

AU - Duncan, Linda

AU - Koch, Joshua D.

AU - Diddle, J. Wesley

AU - Freytag, Joshua

AU - Harris, Amanda

AU - Abraha, Hideat

AU - Butcher, John

AU - Tadphale, Sachin D.

AU - Krawczeski, Catherine D.

AU - Kwiatkowski, David M.

AU - Raymond, Tia T.

AU - Burton, Grant L.

AU - Das, Ashima

AU - Shan, Tajas

AU - Buckley, Jason R.

AU - Schroeder, Luke

AU - Raees, Aanish

AU - Guidry, Bradley

AU - Sosa, Lisa J.

AU - Bailly, David K.

AU - Valentine, Kevin M.

AU - Bhat, Priya N.

AU - Neumayr, Tara M.

AU - Afonso, Natasha S.

AU - O'Neal, Erika R.

AU - Lasa, Javier J.

AU - Huskey, Jordan L.

AU - Phillips, Patrick A.

AU - Ardisana, Amy

AU - Gonzalez, Kim

AU - Columb, Eric

AU - Domar, Tammy

AU - Viers, Suzanne

PY - 2022/11

Y1 - 2022/11

N2 - Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery–associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB). Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay. Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders. Conclusions: Kidney Disease: Improving Global Outcomes–defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.

AB - Background: The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery–associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB). Methods: We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay. Results: Five hundred eighty-two neonates (median age at surgery, 9 days [interquartile range, 5-15], 25% functional single ventricle] were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders. Conclusions: Kidney Disease: Improving Global Outcomes–defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.

UR - http://www.scopus.com/inward/record.url?scp=85122316534&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2021.09.032

DO - 10.1016/j.athoracsur.2021.09.032

M3 - Article

C2 - 34678277

AN - SCOPUS:85122316534

SN - 0003-4975

VL - 114

SP - 1786

EP - 1792

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 5

ER -

Epidemiology of Neonatal Acute Kidney Injury After Cardiac Surgery Without Cardiopulmonary Bypass

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