Risk factors of acute kidney injury in patients after complicated cardiac surgery – the role of low cardiac output syndrome in the postoperative period
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Zakład Anestezjologii i Intensywnej Terapii, Instytut Centrum Zdrowia Matki Polki w Łodzi
Klinika Pediatrii i Immunologii z Pododdziałem Nefrologii, Instytut Centrum Zdrowia Matki Polki w Łodzi
Centrum Medycznej Diagnostyki Laboratoryjnej, Instytut Centrum Zdrowia Matki Polki w Łodzi
Corresponding author
Marcin Tkaczyk
Klinika Pediatrii i Immunologii z Poddożylnego (ketamina), wziewnego (sewofluran), opioidu oddziałem Nefrologii, Instytut Centrum Zdrowia Matki Polki w Łodzi, ul. Rzgowska 281/289, 93-338 Łódź
Med Og Nauk Zdr. 2013;19(1):31-35
Acute kidney injury (AKI) is a frequent complication occurring after cardiac surgery. The objective of the study was the assessment of risk factors of AKI in children who had undergone high­risk complicated cardiac surgery. The study group consisted of 41 children (0­14 y.) operated due to cardiac malformation with high mean Aristotle score (9.25) as a measure of complexity of the procedure. The assessment covered as follows: complexity of procedures, clinical status of the patient, clinical and biochemical indices of cardiac function (NT­proBNP) and AKI by eGFR, and serum concentration of neutrophil gelatinase associated lipocaine concentration (NGAL). A high percentage of AKI was detected in the study group (68%); 20 patients showed stadium R whereas 8 stage I and F. The following factors of AKI (I/F) were identified: lactic academia time, higher dose of catecholamines, high postoperative drainage, and a longer time of mechanical ventilation and stay in ICU. AKI was also related to higher NGAL 24 and 48 hrs after, and higher values on NT­proBNP 24 and 48 hrs after surgery. Conclusion. The development of AKI in I/F was dependent not only on the direct injury of the procedure but also on several factors of the postoperative period with special attention paid to low cardiac output syndrome. Key words: acute kidney injury, cardiac surgery, risk factors, low cardiac output

Dent C, Qing Ma, Dastrala S, Mitsnefes MM, Barasch J, Devarajan P. Plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury, morbidity and mortality after pediatric cardiac surgery:a prospective uncontrolled cohort study. Crit Care. 2007; 11: R127–130.
Bennet M, Dent C, Qing Ma. Urine NGAL predicts severity of acute kidney injury after cardiac surgery:a prospective study. Clin J Am Soc Nephrol. 2008; 3: 665–673.
Krawczeski CD, Woo JG, Wang Y, Bennett MR, Ma Q, Devarajan P. Neutrophil gelatinase-associated lipocalin concentrations predict development of acute kidney injury in neonates and children after cardiopulmonary bypass. J Pediatr. 2011; 158: 1009–1015.
Mishra J, Dent C, Tarbishi R. Neutrophil gelatonase associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005; 365: 1231–1238.
Picca S, Prncipato F, Mazzera E, Corona R, Ferrigno L, Marceletti C, Rizzoni G. Risk of acute renal failure after cardiopulmonary bypass surgery in children: a retrospective 10-year case-control study. Nephrol Dial Transplant. 1995; 10: 630–636.
Ronco C. N-Gal:Diagnosing AKI as soon as possible. Criti Care. 2012; 11: 173–174.
Haase M, Devarajan P, Haase-Fielitz A, Bellomo R, Cruz DN, Wagener G, i wsp. The outcome of neutrophil gelatinase-associated lipocalin- -positive subclinical acute kidney injury: a multicenter pooled analysis of prospective studies. J Am Coll Cardiol. 2011; 57: 1752–1761.
Ricci Z, Ronco C. Kidney diseases beyond nephrology—intensive care. Nephrol Dial Transplant. 2007; 22: 708–711.
Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute Kidney injury: a systematic review. Kidney Int. 2008; 73: 538–546.
Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am. 1981; 34: 571–590.
Schwartz GJ, Feld LG, Langford DJ. A simple estimate of glomerular filtration rate in full-term infants during the first year of life. J Pediatr. 1984; 104: 849–854.
Akcan-Arikan A, Zappitelli M, LoftisLL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007; 71: 1028–1035.
Asfour B, Bruker B, Kehl HG, Frund S, Scheld HH. Renal insufficiency in neonates after cardiac surgery. Clin Nephrol. 1996; 46: 59–63.
Ronco C, Haapio M, House AA, Anavekar N, Bellomo R. Cardiorenal syndrome. J Am Coll Cardiol. 2008; 52: 1527–1539.
Hoffman TM, Wernovsky G, Atz AM, Kulik TJ, Nelson DP, Chang AC, i wsp. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.
Sladen RN, Stafford-Smith M, Greeley WJ. Renal function monitoring; in Miller RD (ed): Miller’s Anesthesia. Anesthesia for pediatric cardiac surgery. Philladelphia, Churchill Livingstone, 2009, pp 234–242.
Solnica B. Peptydy natriuretyczne BNP i NT-proBNP. Med Prakt. 2005; 9: 137–138.
Breuer T, Sapi E, Skoumal R, Sapi E, Toth M, Ala-Kopsala M, i wsp. N-terminal probrain natriuretic peptide level inversely correlates with cardiac index after arterial switch operation in neonates. Pediatr Anesth. 2007; 782–788.
Cantinotti M, Vittorini S, Storti S, Prontera C, Murzi M, De Lucia V, i wsp. Diagnostic accuracy and clinical relevance of brain natriureticmpeptide assay in pediatric patients with congenital heart diseases. J Cardiovasc Med. 2009; 10: 706–713.
Gessler P, Knirsch W, Schmitt B, Rousson V, Von Eckardstein A. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery. J Pediatr. 2006; 148: 372–376.
Mentzer Jr RM, Oz MC, Sladen RN, Graeve AH, Hebeler RF Jr, Luber JF Jr, Smedira NG. Effects of perioperative nesiritide in patients with left ventricular dysfunction undergoing cardiac surgery: The NAPA Trial. J Am Coll Cardiol. 2007; 49: 716–726.
Wagener G, Brentjens TE. Renal disease: the anesthesiologist›s perspective. Anesthesiol Clin. 2006; 24: 523–547.
Brown KL, Ridout DA, Goldman AP, Hoskote A, Penny DJ. Risk factors for long intensive care unit stay after cardiopulmonary bypass in children. Crit Care Med. 2003; 31: 28–33.
Massoudy P, Wagner S, Thielmann M, Herold U, Kottenberg-Assenmacher E, Marggraf G, i wsp. Coronary artery bypass surgery and acute kidney injury – impact of the off-pump technique. Nephrol Dial Transplant. 2008; 23: 2853–2860.
Goldman BS, Tamariz M, Serrick Cl, Sharp E, Noel D, Harwood S, Christakis GT. The influence of cardiopulmonary bypass characteristics on the clinical outcome of 1820 coronary bypass patients. Can J Cardiol. 2003; 19: 237–243.
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