Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-10T06:30:17.819Z Has data issue: false hasContentIssue false
  • English
  • Français

Outcomes of adults with congenital heart disease that experience acute kidney injury in the intensive care unit

Published online by Cambridge University Press:  16 November 2020

Dana Y. Fuhrman Open the ORCID record for Dana Y. Fuhrman [Opens in a new window] ,
Lan Nguyen ,
Emily L. Joyce ,
Priyanka Priyanka  and
John A. Kellum
Dana Y. Fuhrman*
Affiliation:
Department of Critical Care Medicine, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Pediatrics, Division of Pediatric Nephrology, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
Lan Nguyen
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA
Emily L. Joyce
Affiliation:
Department of Pediatrics, Division of Pediatric Nephrology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Priyanka Priyanka
Affiliation:
Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
John A. Kellum
Affiliation:
Department of Critical Care Medicine, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
*
Author for correspondence: Dr D. Y. Fuhrman, DO, MS, University of Pittsburgh Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Children’s Hospital Drive, Faculty Pavilion, Suite 2000, Pittsburgh 15224, PA, USA. Tel: +1 412-692-5164; Fax: +1 412-692-6076. E-mail: dana.fuhrman@chp.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Young adults with congenital heart disease (CHD) are increasing in number with an increased risk for acute kidney injury. Little is known concerning the impact of non-recovery of kidney function for these patients. Therefore, we sought to explore the rates of acute kidney disease, persistent renal dysfunction, and their associations with adverse outcomes in young adults with CHD.

Methods:

This is a single-centre retrospective study including all patients at the ages of 18–40 with CHD who were admitted to an intensive care unit between 2010 and 2014. Patients with a creatinine ≥ 1.5 times the baseline at the time of hospital discharge were deemed to have persistent renal dysfunction, while acute kidney disease was defined as a creatinine ≥ 1.5 times the baseline 7–28 days after a diagnosis of acute kidney injury. Outcomes of death at 5 years and length of hospital stay were examined using multivariable logistic regression and negative binomial regression, respectively.

Results:

Of the (89/195) 45.6% of patients with acute kidney injury, 33.7% had persistent renal dysfunction and 23.6% met the criteria for acute kidney disease. Persistent renal dysfunction [odds ratio (OR), 3.27; 95% confidence interval (CI): 1.15–9.29] and acute kidney disease (OR: 11.79; 95% CI: 3.75–39.09) were independently associated with mortality at 5 years. Persistent renal dysfunction was associated with a longer duration of hospital stay (Incidence Rate Ratio: 1.96; 95% CI: 1.53–2.51).

Conclusions:

In young adults with CHD, acute kidney injury was common and persistent renal dysfunction, as well as acute kidney disease, were associated with increased mortality and length of hospitalisation.

Keywords

Congenital heart diseaseacute kidney injuryacute kidney diseasecardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 274 - 278
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Kellum, JA, Sileanu, FE, Bihorac, A, Hoste, EA, Chawla, LS. Recovery after acute kidney injury. Am J Respir Crit Care Med 2017; 195: 784–791.CrossRefGoogle ScholarPubMed
Chawla, LS, Bellomo, R, Bihorac, A, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol 2017; 13: 241–257.CrossRefGoogle ScholarPubMed
Brown, JR, Kramer, RS, Coca, SG, Parikh, CR. Duration of acute kidney injury impacts long-term survival after cardiac surgery. Ann Thorac Surg 2010; 90: 1142–1148.CrossRefGoogle ScholarPubMed
Dimopoulos, K, Diller, GP, Koltsida, E, et al. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 2008; 117: 2320–2328.CrossRefGoogle ScholarPubMed
Buelow, MW, Dall, A, Bartz, PJ, et al. Renal dysfunction is common among adults after palliation for previous tetralogy of Fallot. Pediatr Cardiol 2013; 34: 165–169.CrossRefGoogle ScholarPubMed
Kwiatkowski, DM, Price, E, Axelrod, DM, et al. Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease. Cardiol Young 2017; 27: 1068–1075.CrossRefGoogle ScholarPubMed
Madsen, NL, Goldstein, SL, Froslev, T, Christiansen, CF, Olsen, M. Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int 2017; 92: 751–756.CrossRefGoogle ScholarPubMed
Fuhrman, DY, Nguyen, LG, Sanchez-de-Toledo, J, Priyanka, P, Kellum, JA. Postoperative acute kidney injury in young adults with congenital heart disease. Ann Thorac Surg 2019; 107: 1416–1420.CrossRefGoogle ScholarPubMed
Jenkins, KJ, Correa, A, Feinstein, JA, et al. Non-inherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 2007; 115: 2995–3014.CrossRefGoogle Scholar
Mizuno, T, Sato, W, Ishikawa, K, et al. KDIGO (Kidney Disease: Improving Global Outcomes) criteria could be a useful outcome predictor of cisplatin-induced acute kidney injury. Oncology 2012; 82: 354–359.CrossRefGoogle ScholarPubMed
Levey, AS, Bosch, JP, Lewis, JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of diet in renal disease study group. Ann Intern Med 1999; 130: 461–470.CrossRefGoogle ScholarPubMed
Zavada, J, Hoste, E, Cartin-Ceba, R, et al. A comparison of three methods to estimate baseline creatinine for RIFLE classification. Nephrol Dial Transplant 2010; 25: 3911–3918.CrossRefGoogle ScholarPubMed
Vincent, JL, Moreno, R, Takala, J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 1996; 22: 707–710.CrossRefGoogle Scholar
Swaminathan, M, Hudson, CC, Phillips-Bute, BG, et al. Impact of early renal recovery on survival after cardiac surgery-associated acute kidney injury. Ann Thorac Surg 2010; 89: 1098–1104.CrossRefGoogle ScholarPubMed
Kaddourah, A, Basu, RK, Bagshaw, SM, Goldstein, SL, Investigators, A. Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 2017; 376: 11–20.CrossRefGoogle ScholarPubMed
Supplementary material: File

Fuhrman et al. supplementary material

Table S1

Download Fuhrman et al. supplementary material(File)
File 52.1 KB