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Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease

Published online by Cambridge University Press:  21 November 2016

David M. Kwiatkowski Open the ORCID record for David M. Kwiatkowski [Opens in a new window] ,
Elizabeth Price ,
David M. Axelrod ,
Anitra W. Romfh ,
Brian S. Han ,
Scott M. Sutherland  and
Catherine D. Krawczeski
David M. Kwiatkowski*
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Elizabeth Price
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
David M. Axelrod
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Anitra W. Romfh
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Brian S. Han
Affiliation:
Department of Pediatrics, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Scott M. Sutherland
Affiliation:
Division of Nephrology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
Catherine D. Krawczeski
Affiliation:
Division of Cardiology, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
*
Correspondence to: D. M. Kwiatkowski, MD, MS, Division of Pediatric Cardiology, Lucile Packard Children’s Hospital Stanford, Suite 325, 750 Welch Road, Palo Alto, CA 94304-5731, United States of America. Tel: +1 650 721 3290; Fax: +1 650 725 8343; E-mail: david.kwiatkowski@stanford.edu
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Abstract

Background

Acute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.

Methods

This single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.

Results

Data from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.

Conclusions

We demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.

Keywords

Adult CHDacute kidney injurycardiopulmonary bypasscardiorenal interactions
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 6 , August 2017 , pp. 1068 - 1075
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Copyright
© Cambridge University Press 2016 

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