Risk factors associated with acute kidney injury after corrective surgery for tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Tuo ¹ ,  WANG Xun ²

1. Fu Wai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100037, P.R.China;
2. Department of Pediatric Intensive Care Unit, Fu Wai Hospital, Cardiovascular Institute, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Xun, Email: fwpicu@163.com

Keywords：

Tetralogy of Fallot; acute kidney injury; pediatric intensive care; cardiac surgery

DOI：

10.7507/1007-4848.201610009

Video：

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Objective To explore risk factors related to acute kidney injury (AKI) in children who underwent corrective surgery for tetralogy of Fallot (TOF). Methods We retrospectively analyzed the clinical data of 726 children with corrective procedures for TOF aged less than 3 years in our hospital from March 1st 2010 to March 1st 2013. Children with AKI were picked using Acute Kidney Injury Network criteria. Demographic and perioperative variables of the remaining patients were reviewed. Univariate analysis was performed to compare the AKI group (240 patients) with the non-AKI group (486 patients). Multivariable analysis was carried out to identify significant determinants of AKI. Results A total of 240 children were with AKI. The result of univariate analysis showed that there was a statistical difference in age, Nakata index, McGoon ratio, left ventricular end-diastolic volume index (LVEDVI), transannular right ventricular outflow tract (RVOT) patch, or fresh frozen plasma (FFP) in prime solution between the AKI group and the non-AKI group. Multivariable logistic regression showed that in older children (OR=1.425, 95% CI 1.071 to 1.983, P=0.011) with more transfusion of FFP in the priming solution (OR=1.486, 95% CI 1.325 to 2.674, P<0.001) led to higher morbidity of mild AKI. In addition, there was an increase in morbidity related to AKI when children had less Nakata index (OR=0.282, 95% CI 0.092 to 0.869, P=0.013). Conclusion Postoperative AKI increases in older children group. Infusion of more FFP in priming solution increases morbidity of AKI. The less Nakata index is significantly associated with severe AKI.

Citation： PAN Tuo, WANG Xun. Risk factors associated with acute kidney injury after corrective surgery for tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 495-500. doi: 10.7507/1007-4848.201610009 Copy

1.	Wu KH, Lü XD, Liu YL. Recent progress of pediatric cardiac surgery in China. Chin Med J, 2006; 119(23): 2005-2012.
2.	Shian WJ, Chi CS, Chen JW, et al. Hypoxic-ischemic effect on infants and children with cyanotic congenital heart disease: clinical assessment of neurological examination and brain magnetic resonance images. Chin Med J, 1994, 53(3): 154-157.
3.	Crowley MA, Mollan TL, Abdulmalik OY, et al. A hemoglobin variant associated with neonatal cyanosis and anemia. NEJM, 2011, 364(19): 1837.
4.	Ferrario M, Morte MD, Boyer A, et al. Cyanosis from methemoglobinemia. Minerva Pneumologica, 2011, 50: 63-65.
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7.	Blinder JJ, Goldstein SL, Lee VV, et al. Congenital heart surgery in infants: Effects of acute kidney injury on outcome. J Thorac Cardiov Surg, 2012, 143: 368-374.
8.	Haase M, Bellomo R, Matalanis G, et al. A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc Surg, 2009, 138: 1370-1376.
9.	Lopes JA, Fernandes P, Jorge S, et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care, 2008, 12(4): R110.
10.	Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2): 234-238.
11.	Hazle MA, Gajarski RJ, Blatt NB, et al. Fluid overload in infants following congenital heart surgery. Pediatr Care Med, 2013, 14(1): 4-49.
12.	Doyle RA, Dhir AK, Moors AH, et al. Treatment of perioperative low cardiac output syndrome. Ann Thorac Surg, 1995, 59(2 Suppl): S3-S11.
13.	Klein L, O’Connor CM, Gattis WA, et al. Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations. Am J Cardiol, 2003, 91(9A): 18F-40F.
14.	Vincent JL. Determination of oxygen delivery and consumption versus cardiac index and oxygen extraction ratio. Crit Care Clin, 1996, 12(4): 995-1006.
15.	Miao X, Liu J, Hu S, et al. The influence of cardiopulmonary bypass priming without FFP on postoperative coagulation and recovery in pediatric patients with cyanotic congenital heart disease. Eur J Pediatr, 2014, 173(11): 1437-1443.
16.	Frenette AJ, Bouchard J, Bernier P, et al. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis. Crit Care, 2014, 18(6): 602.
17.	Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery. J Card Surg, 2014, 30(1): 92-96.
18.	Hoste EA,Kellum JA, Katz NM, et al. Epidemiology of acute kidney injury. Contrib Nephrol. 2010, 165: 1-8.
19.	Li SL, Zhang YJ, Li SJ, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenit Heart Dis, 2015, 10(3): 254-262.

1. Wu KH, Lü XD, Liu YL. Recent progress of pediatric cardiac surgery in China. Chin Med J, 2006; 119(23): 2005-2012.
2. Shian WJ, Chi CS, Chen JW, et al. Hypoxic-ischemic effect on infants and children with cyanotic congenital heart disease: clinical assessment of neurological examination and brain magnetic resonance images. Chin Med J, 1994, 53(3): 154-157.
3. Crowley MA, Mollan TL, Abdulmalik OY, et al. A hemoglobin variant associated with neonatal cyanosis and anemia. NEJM, 2011, 364(19): 1837.
4. Ferrario M, Morte MD, Boyer A, et al. Cyanosis from methemoglobinemia. Minerva Pneumologica, 2011, 50: 63-65.
5. Goldschmidt B. Blood coagulation and platelet abnormalities in cyanotic congenital heart-disease. Lancet, 1973, 1(7803): 607.
6. Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kid Dis, 2010, 55(2): 316-325.
7. Blinder JJ, Goldstein SL, Lee VV, et al. Congenital heart surgery in infants: Effects of acute kidney injury on outcome. J Thorac Cardiov Surg, 2012, 143: 368-374.
8. Haase M, Bellomo R, Matalanis G, et al. A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc Surg, 2009, 138: 1370-1376.
9. Lopes JA, Fernandes P, Jorge S, et al. Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care, 2008, 12(4): R110.
10. Gaies MG, Gurney JG, Yen AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med, 2010, 11(2): 234-238.
11. Hazle MA, Gajarski RJ, Blatt NB, et al. Fluid overload in infants following congenital heart surgery. Pediatr Care Med, 2013, 14(1): 4-49.
12. Doyle RA, Dhir AK, Moors AH, et al. Treatment of perioperative low cardiac output syndrome. Ann Thorac Surg, 1995, 59(2 Suppl): S3-S11.
13. Klein L, O’Connor CM, Gattis WA, et al. Pharmacologic therapy for patients with chronic heart failure and reduced systolic function: review of trials and practical considerations. Am J Cardiol, 2003, 91(9A): 18F-40F.
14. Vincent JL. Determination of oxygen delivery and consumption versus cardiac index and oxygen extraction ratio. Crit Care Clin, 1996, 12(4): 995-1006.
15. Miao X, Liu J, Hu S, et al. The influence of cardiopulmonary bypass priming without FFP on postoperative coagulation and recovery in pediatric patients with cyanotic congenital heart disease. Eur J Pediatr, 2014, 173(11): 1437-1443.
16. Frenette AJ, Bouchard J, Bernier P, et al. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis. Crit Care, 2014, 18(6): 602.
17. Güvener M, Korun O, Demirtürk OS. Risk factors for systemic inflammatory response after congenital cardiac surgery. J Card Surg, 2014, 30(1): 92-96.
18. Hoste EA,Kellum JA, Katz NM, et al. Epidemiology of acute kidney injury. Contrib Nephrol. 2010, 165: 1-8.
19. Li SL, Zhang YJ, Li SJ, et al. Risk factors associated with prolonged mechanical ventilation after corrective surgery for tetralogy of Fallot. Congenit Heart Dis, 2015, 10(3): 254-262.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors associated with acute kidney injury after corrective surgery for tetralogy of Fallot

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