Attending Physician, Pediatric Cardiac Critical Care Advocate Children's Hospital Orland Park, Illinois, United States
Abstract: Background Acute Kidney Injury (AKI) after pediatric cardiac surgery is manifested by injury along multiple pathways. One of these is oxidative injury related to hemolysis and subsequent deposition of hemoglobin in the kidney. Acetaminophen inhibits hemoprotein-catalyzed lipid peroxidation associated with hemolysis and in turn, may attenuate renal injury.
Methods We performed a retrospective study of patients undergoing pediatric cardiac surgery. A randomized controlled trial dictated a regimented, high dosage, acetaminophen. A historical cohort who received ad hoc acetaminophen and that met the same inclusion/exclusion criteria were also analyzed. Important inclusion criteria included age 3 months to 4 years who underwent cardiac surgery via midline sternotomy and were extubated within three hours of admission. Patients with pre-existing or chronic kidney disease were excluded.
Results A total of 181 patients were included. Of these, 69 (38%) developed AKI. There were no significant pre- or intra-operative risk differences in characteristics between those who developed AKI and those who did not. Acetaminophen dose did significantly differ between those who developed AKI and those who did not with lower acetaminophen dose in the acute kidney injury group (30 mg/kg versus 50mg/kg, p-value=0.01). A multivariate analysis was performed which found that higher acetaminophen dosage and lower immediate post-operative hemoglobin were independently associated with a lower risk of AKI.
Conclusion Acute kidney injury occurs in approximately 38% after pediatric cardiac surgery. After adjusting for other covariables, acetaminophen use is associated with lower risk of acute kidney injury.
