TY - JOUR
T1 - Higher total ultrafiltration volume during cardiopulmonary bypass-assisted infant cardiac surgery is associated with acute kidney injury and fluid overload
AU - Zanaboni, Dominic
AU - Min, Jungwon
AU - Seshadri, Roopa
AU - Gaynor, J. William
AU - Dreher, Molly
AU - Blinder, Joshua J.
N1 - Funding Information:
This research was supported in part by the Cardiac Center Clinical Research Core at the Children’s Hospital of Philadelphia.
Publisher Copyright:
© 2021, IPNA.
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Cardiopulmonary bypass (CPB)
KW - Children
KW - Complications
KW - Congenital heart disease
KW - Dialysis
KW - Inflammatory response
KW - Kidney failure
UR - http://www.scopus.com/inward/record.url?scp=85101865686&partnerID=8YFLogxK
U2 - 10.1007/s00467-021-04976-2
DO - 10.1007/s00467-021-04976-2
M3 - Article
C2 - 33651177
AN - SCOPUS:85101865686
SN - 0931-041X
VL - 36
SP - 2875
EP - 2881
JO - Pediatric Nephrology
JF - Pediatric Nephrology
IS - 9
ER -