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Urine biomarkers, acute kidney injury, and fluid overload in neonatal cardiac surgery

Published online by Cambridge University Press:  06 February 2025

Rebecca D. Sullenger Open the ORCID record for Rebecca D. Sullenger [Opens in a new window] ,
Alison G. Kilborn ,
Reid C. Chamberlain Open the ORCID record for Reid C. Chamberlain [Opens in a new window] ,
Kevin D. Hill Open the ORCID record for Kevin D. Hill [Opens in a new window] ,
Rasheed A. Gbadegesin Open the ORCID record for Rasheed A. Gbadegesin [Opens in a new window] ,
Christoph P. Hornik Open the ORCID record for Christoph P. Hornik [Opens in a new window]  and
Elizabeth J. Thompson Open the ORCID record for Elizabeth J. Thompson [Opens in a new window]
Rebecca D. Sullenger
Affiliation:
Duke University School of Medicine, Durham, NC, USA
Alison G. Kilborn
Affiliation:
Duke Clinical Research Institute, Durham, NC, USA
Reid C. Chamberlain
Affiliation:
Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Kevin D. Hill
Affiliation:
Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Rasheed A. Gbadegesin
Affiliation:
Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Christoph P. Hornik
Affiliation:
Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA Department of Pediatrics, Duke University Hospital, Durham, NC, USA
Elizabeth J. Thompson*
Affiliation:
Duke University School of Medicine, Durham, NC, USA Duke Clinical Research Institute, Durham, NC, USA Department of Pediatrics, Duke University Hospital, Durham, NC, USA
*
Corresponding author: Elizabeth J. Thompson; Email: liz.thompson@duke.edu
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Abstract

Background:

Cardiac surgery-associated acute kidney injury (CS-AKI) and fluid overload (FO) are common among neonates who undergo cardiopulmonary bypass, and increase mortality risk. Current diagnostic criteria may delay diagnosis. Thus, there is a need to identify urine biomarkers that permit earlier and more accurate diagnosis.

Methods:

This single-centre ancillary prospective cohort study describes age- and disease-specific ranges of 14 urine biomarkers at perioperative time points and explores associations with CS-AKI and FO. Neonates (≤28 days) undergoing cardiac surgery were included. Preterm neonates or those who had pre-operative acute kidney injury were excluded. Urine biomarkers were measured pre-operatively, at 0 to < 8 hours after surgery, and at 8 to 24 hours after surgery. Exploratory outcomes included CS-AKI, defined by the modified Kidney Disease Improving Global Outcomes criteria, and>10% FO, both measured at 48 hours after surgery.

Results:

Overall, α-glutathione S-transferase, β-2 microglobulin, albumin, cystatin C, neutrophil gelatinase-associated lipocalin, osteopontin, uromodulin, clusterin, and vascular endothelial growth factor concentrations peaked in the early post-operative period; over the sampling period, kidney injury molecule-1 increased and trefoil factor-3 decreased. In the early post-operative period, β-2 microglobulin and α-glutathione S-transferase were higher in neonates who developed CS-AKI; and clusterin, cystatin C, neutrophil gelatinase-associated lipocalin, osteopontin, and α-glutathione S-transferase were higher in neonates who developed FO.

Conclusion:

In a small, single-centre cohort, age- and disease-specific urine biomarker concentrations are described. These data identify typical trends and will inform future studies.

Keywords

Acute kidney injurybiomarkersurinecardiopulmonary bypassneonatepaediatric
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 9
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Copyright
© The Author(s), 2025. Published by Cambridge University Press

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