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Incidence and impact of acute kidney injury in patients with hypoplastic left heart syndrome following the hybrid stage 1 palliation

Published online by Cambridge University Press:  02 December 2020

Tyler W. Cunningham Open the ORCID record for Tyler W. Cunningham [Opens in a new window] ,
Yubo Tan ,
Catherine D. Krawczeski ,
John D. Spencer ,
Shasha Bai ,
Christina Phelps  and
Andrew R. Yates
Tyler W. Cunningham*
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
Yubo Tan
Affiliation:
Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
Catherine D. Krawczeski
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
John D. Spencer
Affiliation:
Section of Nephrology, Nationwide Children’s Hospital, Columbus, OH, USA
Shasha Bai
Affiliation:
Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, USA
Christina Phelps
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
Andrew R. Yates
Affiliation:
The Heart Center, Nationwide Children’s Hospital, Columbus, OH, USA
*
Author for correspondence: Dr T. W. Cunningham, The Heart Center, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus 43205-2664, OH, USA. Tel: +1 614 722 3821; Fax: +1 614 722 2549. E-mail: tcunningha3@gmail.com
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Abstract

Objective:

Acute kidney injury leads to worse outcomes following paediatric cardiac surgery. There is a lack of literature focusing on acute kidney injury after the Hybrid stage 1 palliation for single ventricle physiology. Patients undergoing the Hybrid Stage 1, as a primary option, may have a lower incidence of kidney injury than previously reported. When present, kidney injury may increase the risk of post-operative morbidity and mortality.

Methods:

A retrospective, single centre review was conducted in patients with hypoplastic left heart syndrome who underwent Hybrid Stage 1 from 2008 to 2018. Acute kidney injury was defined as a dichotomous yes (meeting any injury criteria) or no (no injury) utilising two different criteria utilised in paediatrics. The impact of kidney injury on perioperative characteristics and 30-day mortality was analysed.

Results:

The incidence of acute kidney injury is 13.4–20.7%, with a severe injury rate of 2.4%. Patients without a prenatal diagnosis of hypoplastic left heart syndrome have a higher incidence of kidney injury than those prenatally diagnosed, (40% versus 14.5%, p = 0.024). Patients with acute kidney injury have a significantly higher incidence of 30-day mortality, 27.3%, compared to without, 5.6% (p = 0.047).

Discussion:

The incidence of severe acute kidney injury after the Hybrid Stage 1 palliation is low. A prenatal diagnosis may be associated with a lower incidence of kidney injury following the Hybrid Stage 1. Though uncommon, severe acute kidney injury following Hybrid Stage 1 may be associated with higher 30-day mortality.

Keywords

Univentricular heartacute kidney injuryNorwood procedurehybrid procedure
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 3 , March 2021 , pp. 414 - 420
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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