Performance of Fluid Balance as A Marker of Acute Kidney Injury in Children after Open Heart Surgery

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Abstract

Acute kidney injury (AKI) is a serious complication in the perioperative period and is consistently associated with increased morbidity and case fatality rate. This has been best studied in the cardiac surgery setting where it has been shown that up to 11.5–86.0% of patients exposed to cardiopulmonary bypass (CPB) will develop AKI, with 2.0–18.9% requiring renal replacement therapy (RRT). A prospective uncontrolled cohort study was conducted between 2011 and 2015, in which 93 children with various congenital heart lesions undergoing CPB were enrolled. Serum creatinine (SCr) level was determined by Jaffé’s method (Cobas 6000 analyser, Roche). Postoperative fluid balance was estimated as the difference between fluid intake and output. Data for further processing were retrieved from anaesthesia and intensive care data management system flowsheets (IntelliView, Philips). AKI developed in 42 patients (45.6%) by meeting at least KDIGO (Kidney Disease: Improving Global Outcomes) stage I criteria (with SCr rise by more than 50% from the baseline). Thirty eight patients complied with the 1st stage of AKI, three with 2nd stage and two with 3rd stage, according the KDIGO classification and staging system. One patient having severity stage II and two patients having severity stage III of AKI required initiation of RRT using peritoneal dialysis. Two patients from the RRT group survived, one died. The median intraoperative urine output was 2.32 ml/kg/h, (range from 0.42–5.87 ml/kg/h). Median CPB time was 163 min., median aortic cross-clamping time was 97.9 min., cooling during CPB to 29.5 °C. The diagnosis of AKI using SCr was delayed by 48 hours after CPB. Median fluid balance (FB) on the first postoperative day in non-AKI patients was 13.58 ml/kg (IQR 0–37.02) vs 49.38 ml/kg (IQR 13.20–69.32) in AKI patients, p < 0.001. AKI is a frequent complication after open heart surgery in children with congenital heart lesions. From 93 patients included in the study, 42 (45.2%) met at least KDIGO Stage I criteria for AKI. FB is a sensitive marker of kidney dysfunction. Median FB in the 1st postoperative day significantly differed between AKI patients: 49.38 ml/kg (13.20–69.32) versus 13.58 ml/kg in patients with intact kidney function (AUC = 0.84; p = 0.001). Thus it can be used as a marker of AKI.

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  • Bagshaw S. M. Brophy P. D. Cruz D. Ronco C. (2008). Fluid balance as a biomarker: Impact of fluid overload on outcome in critically ill patients with acute kidney injury. Crit. Care12 (4) 169.

  • Hassinger A. B. Wald E. L. Goodman D. M. (2014). Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr. Crit. Care Med. 15 131–138.

  • Hazle M. A. Gajarski R. J. Yu S. Donohue J. Blatt N. B. (2013). Fluid overload in infants following congenital heart surgery. Pediatr. Crit. Care Med. 14 44–49.

  • Horiguchi Y. Uchiyama A. Iguchi N. Sakai K. Hiramatsu D. Ueta K. Ohta N. Fujino Y. (2014). Perioperative fluid balance affects staging of acute kidney injury in postsurgical patients: A retrospective case-control study. J. Intensive Care2 (1) 2–6.

  • Kellum J. A. Lameire N. Aspelin P. et al. (2012). Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO Clinical Practice Guideline for Acute Kidney Injury. Kidney Int. 2 1–138.

  • Lane P. H. Mauer S. M. Blazar B. R. Ramsay N. K. Kashtan C. E. (1994). Outcome of dialysis for acute renal failure in pediatric bone marrow transplant patients. Bone Marrow Transplant. 13 (5) 613–617.

  • Lex D. J. Tóth R. Czobor N. R. Alexander S. I. Breuer T. Sápi E. Szatmári A. Székely E. Gál J. Székely A. (2016). Fluid overload is associated with higher mortality and morbidity in pediatric patients undergoing cardiac surgery. Pediatr. Crit. Care Med. 17 307–314.

  • Pedersen K. R. Hjortdal V. E. Christensen S. Pedersen J. Hjortholm K. Larsen S. H. Povlsen J. V. (2008). Clinical outcome in children with acute renal failure treated with peritoneal dialysis after surgery for congenital heart disease. Kidney Int. Suppl. S81–86.

  • Shi S. Zhao Z. Liu X. Shu Q. Tan L. Lin R. Shi Z. Fang X. (2008). Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest134 (4) 768–774.

  • Sorof J. M. Stromberg D. Brewer E. D. Feltes T. F. Fraser C. D. Jr. (1999). Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr. Nephrol. 13 641–645.

  • Sutherland S. M. Zappitelli M. Alexander S. R. et al. (2010). Fluid overload and mortality in children receiving continuous renal replacement therapy: The prospective pediatric continuous renal replacement therapy registry. Amer. J. Kidney Dis. 55 (2) 316–325.

  • Van Biesen W. Yegenaga I. Vanholder R. Verbeke F. Hoste E. Colardyn F. Lameire N. (2005). Relationship between fluid status and its management on acute renal failure (ARF) in Intensive Care Unit (ICU) patients with sepsis: A prospective analysis. J. Nephrol. 18 54–60.

  • Wauters J. Claus P. Brosens N. McLaughlin M. Malbrain M. Wilmer A. (2009). Pathophysiology of renal hemodynamics and renal cortical microcirculation in a porcine model of elevated intra-abdominal pressure. J Trauma66 713–719.

  • Zhang S. Wang S. Yao S. (2004). Evidence for development of capillary leak syndrome associated with cardiopulmonary bypass in pediatric patients with the homozygous C4A null phenotype. Anesthesiology100 1387–1393.

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