Jef Van den Eynde1,2, Boris Delpire3, Xander Jacquemyn3, Ismat Pardi3, Hajar Rotbi4,5, Marc Gewillig3,6, Shelby Kutty7, Djalila Mekahli8,9. 1. Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA. jef.vandeneynde@student.kuleuven.be. 2. Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. jef.vandeneynde@student.kuleuven.be. 3. Department of Cardiovascular Sciences, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium. 4. Faculty of Medicine, Radboud University, Nijmegen, The Netherlands. 5. Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands. 6. Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium. 7. Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, USA. 8. Department of Pediatric Nephrology, University Hospitals of Leuven, Leuven, Belgium. 9. PKD Research Group, GPURE, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Abstract
BACKGROUND: Cardiac surgery-associated acute kidney injury (AKI) is associated with increased morbidity and mortality in both adults and children. OBJECTIVES: This study aimed to identify clinical risk factors for AKI following cardiac surgery in the pediatric population. DATA SOURCES: PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. STUDY ELIGIBILITY CRITERIA: Studies were included if (1) the population consisted of pediatric patients (< 18 years old), (2) patients underwent cardiac surgery, (3) risk factors were compared between patients who developed AKI and those who did not, and (4) studies were prospective or retrospective observational studies or randomized controlled trials. PARTICIPANTS AND INTERVENTIONS: Children undergoing pediatric cardiac surgery. STUDY APPRAISAL AND SYNTHESIS METHODS: Random-effects meta-analysis was performed, comparing potential risk factors between pediatric patients who developed CS-AKI and those who did not. RESULTS: Sixty-one publications including a total of 19,680 participants (AKI: 7257 participants; no AKI: 12,423 participants) were included from studies published between 2008 and 2020. The pooled estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%, I2 = 96.8%). Binary risk factors that were significantly and consistently associated with AKI were the presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, risk adjustment for congenital heart surgery 1 (RACHS-1) score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis. Significant continuous risk factors included younger age, lower body weight, lower preoperative creatinine, higher preoperative estimated glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery time, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and higher red blood cell transfusion volume. LIMITATIONS: Results are limited by heterogeneity and potential residual confounding. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Our meta-analysis identified clinical risk factors that are associated with AKI in children undergoing cardiac surgery. This might help clinicians anticipate and manage more carefully this population and implement standardized preventive strategies. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42021262699. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Cardiac surgery-associated acute kidney injury (AKI) is associated with increased morbidity and mortality in both adults and children. OBJECTIVES: This study aimed to identify clinical risk factors for AKI following cardiac surgery in the pediatric population. DATA SOURCES: PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for studies published by August 2020. STUDY ELIGIBILITY CRITERIA: Studies were included if (1) the population consisted of pediatric patients (< 18 years old), (2) patients underwent cardiac surgery, (3) risk factors were compared between patients who developed AKI and those who did not, and (4) studies were prospective or retrospective observational studies or randomized controlled trials. PARTICIPANTS AND INTERVENTIONS: Children undergoing pediatric cardiac surgery. STUDY APPRAISAL AND SYNTHESIS METHODS: Random-effects meta-analysis was performed, comparing potential risk factors between pediatric patients who developed CS-AKI and those who did not. RESULTS: Sixty-one publications including a total of 19,680 participants (AKI: 7257 participants; no AKI: 12,423 participants) were included from studies published between 2008 and 2020. The pooled estimated incidence of AKI was 34.3% (95% confidence interval 30.0-38.8%, I2 = 96.8%). Binary risk factors that were significantly and consistently associated with AKI were the presence of pulmonary hypertension, cyanotic heart disease, univentricular heart, risk adjustment for congenital heart surgery 1 (RACHS-1) score ≥ 3, vasopressor use, cardiopulmonary bypass use, reoperation, and sepsis. Significant continuous risk factors included younger age, lower body weight, lower preoperative creatinine, higher preoperative estimated glomerular filtration rate (eGFR), higher RACHS-1 score, longer surgery time, longer cardiopulmonary bypass time, longer aortic cross-clamp time, and higher red blood cell transfusion volume. LIMITATIONS: Results are limited by heterogeneity and potential residual confounding. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Our meta-analysis identified clinical risk factors that are associated with AKI in children undergoing cardiac surgery. This might help clinicians anticipate and manage more carefully this population and implement standardized preventive strategies. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42021262699. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: Claudia A Algaze; Andrew M Koth; Lisa W Faberowski; Frank L Hanley; Catherine D Krawczeski; David M Axelrod Journal: Pediatr Crit Care Med Date: 2017-01 Impact factor: 3.624
Authors: Joshua J Blinder; Lisa A Asaro; David Wypij; David T Selewski; Michael S D Agus; Michael Gaies; Michael A Ferguson Journal: Pediatr Crit Care Med Date: 2017-07 Impact factor: 3.624
Authors: David T Selewski; Jennifer R Charlton; Jennifer G Jetton; Ronnie Guillet; Maroun J Mhanna; David J Askenazi; Alison L Kent Journal: Pediatrics Date: 2015-07-13 Impact factor: 7.124
Authors: A Akcan-Arikan; M Zappitelli; L L Loftis; K K Washburn; L S Jefferson; S L Goldstein Journal: Kidney Int Date: 2007-03-28 Impact factor: 10.612
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097