Clinical Assistant Professor, Department of Pediatrics NYU Langone Health/NYU Grossman School of Medicine New York, New York, United States
Abstract:
Introduction: Cardiac Surgery-associated Acute Kidney Injury (CS-AKI) is common and associated with adverse outcomes. Prior work from the Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) demonstrated that only stage 3 AKI was associated with mortality. Given persistent AKI has been associated with worse outcomes in this population, we hypothesize that phenotyping CS-AKI based on duration after the Norwood procedure (NP) will associate with morbidity and mortality.
Methods: Multicenter retrospective cohort study from NEPHRON of consecutive neonates undergoing the NP. Patients supported by pre- or post-operative ECMO were excluded. CS-AKI was defined using the modified neonatal Kidney Disease: Improving Global Outcomes serum creatinine or urine output (UOP) criteria. UOP criteria were only used in the presence of an indwelling bladder catheter. Transient CS-AKI was defined as resolved by POD 3, and persistent CS-AKI as still present on/after POD 3. Severe CS-AKI was stage 2 or 3.
Results: Three-hundred forty-six patients were included. Of 211 (61.0%) with CS-AKI, 127 (36.7%) were transient, 29 (8.4%) severe transient, 78 persistent (22.5%) and 23 (6.6%) severe persistent. Only 5 (1.4%) had delayed onset CS-AKI and were not included in comparative analysis. On univariate analysis, patients that developed persistent CS-AKI had lower cardiac intensive care unit admit systolic blood pressure, higher vasoactive inotrope score, higher % fluid overload on POD 0, 1, and more major post-op complications. Of the 15% who underwent prophylactic peritoneal dialysis, 30/51 (58.9%) had transient and 10/51 (19.6%) had persistent CS-AKI. Transient and persistent CS-AKI occurred less frequently in patients exposed to preoperative feeds (Table 1). Patients with persistent CS-AKI had 3.5 times higher mortality than no AKI. However, on multivariable analysis, persistent CS-AKI was not associated with mortality, respiratory support free days at 28 days, and hospital free days at 60 days (Table 2).
Conclusion: After the Norwood procedure, neither transient nor persistent CS-AKI are associated with important outcomes in this multicenter high-risk cohort after controlling for other risk factors and postoperative complications. Exploring other definitions of clinical CS-AKI that associate with outcomes in this high-risk population is paramount to improving patient care.
