Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload

Dominic Zanaboni, Jungwon Min, Roopa Seshadri, J. William Gaynor, Molly Dreher, Joshua J. Blinder

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Ultrafiltration (UF) is used for fluid removal during and after infant cardiopulmonary bypass (CPB) surgery to reduce fluid overload. Excessive UF may have the opposite of its intended effect, resulting in acute kidney injury (AKI), oliganuria, and fluid retention. Methods: This is a single-center, retrospective review of infants treated with conventional and/or modified UF during CPB surgery. UF volume was indexed to weight. AKI was defined using serum creatinine “Kidney Disease Improving Global Outcome (KDIGO)” criteria. Fluid balance was defined according to: [total intake(mL)−total output(mL)preoperative weight(g)]x100. Peak fluid overload was determined on postoperative day 3. Multivariable logistic regression adjusted for multiple covariates was used to explore associations with UF, AKI, and fluid overload. Results: Five hundred thirty subjects < 1 year of age underwent CPB-assisted congenital heart surgery with UF. Sixty-four (12%) developed postoperative AKI. On multivariable regression, higher indexed total UF volume was associated with increased AKI risk (OR 1.11, 95% CI=1.04–1.19, p = 0.003). UF volume > 119.9 mL/kg did not reduce peak fluid overload. Subjects with AKI took longer to reach a negative fluid balance (2 vs. 3 days, p = 0.04). Those with more complex surgery were at highest AKI risk (STAT 3 [25–75 percentile: 3–4] in AKI group versus STAT 3 [25–75 percentile: 2–4] in non-AKI group, p = 0.05). AKI was reduced in subjects undergoing more complex surgery and treated with UF volume < 119.9 mL/kg. Conclusions: Judicious use of UF in more complex congenital cardiac surgery reduces the risk of AKI.

Original languageEnglish
Pages (from-to)2875-2881
Number of pages7
JournalPediatric Nephrology
Volume36
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • Cardiopulmonary bypass (CPB)
  • Children
  • Complications
  • Congenital heart disease
  • Dialysis
  • Inflammatory response
  • Kidney failure

Fingerprint

Dive into the research topics of 'Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload'. Together they form a unique fingerprint.

Cite this