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Transient and persistent acute kidney injury phenotypes following the Norwood operation: a retrospective study

Published online by Cambridge University Press:  08 July 2021

Katja M. Gist Open the ORCID record for Katja M. Gist [Opens in a new window] ,
Santiago Borasino ,
Megan SooHoo ,
Danielle E. Soranno ,
Emily Mack ,
Kristal M. Hock Open the ORCID record for Kristal M. Hock [Opens in a new window] ,
A.K.M. Fazlur Rahman ,
John T. Brinton ,
Rajit K. Basu  and
Jeffrey A. Alten
Katja M. Gist*
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Santiago Borasino
Affiliation:
Division of Cardiology, Section of Cardiac Critical Care Medicine, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
Megan SooHoo
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Danielle E. Soranno
Affiliation:
Section of Pediatric Nephrology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Emily Mack
Affiliation:
Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, Aurora, CO, USA
Kristal M. Hock
Affiliation:
Division of Cardiology, Section of Cardiac Critical Care Medicine, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
A.K.M. Fazlur Rahman
Affiliation:
Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
John T. Brinton
Affiliation:
Department of Biostatistics and Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
Rajit K. Basu
Affiliation:
Children’s Healthcare of Atlanta, Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
Jeffrey A. Alten
Affiliation:
Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine;, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
*
Author for correspondence: Katja M. Gist, Division of Pediatric Cardiology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children’s Hospital Colorado, 13123 E 16th Ave, B100, Aurora, CO 80045, USA. Tel: 720-777-3614. E-mail: Katja.gist@childrenscolorado.org
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Abstract

Background:

Acute kidney injury is a common complication following the Norwood operation. Most neonatal studies report acute kidney injury peaking within the first 48 hours after cardiac surgery. The aim of this study was to evaluate if persistent acute kidney injury (>48 postoperative hours) after the Norwood operation was associated with clinically relevant outcomes.

Methods:

Two-centre retrospective study among neonates undergoing the Norwood operation. Acute kidney injury was initially identified as developing within the first 48 hours after cardiac surgery and stratified into transient (≤48 hours) and persistent (>48 hours) using the neonatal modification of the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Severe was defined as stage ≥2. Primary and secondary outcomes were mortality and duration of ventilation and hospital length of stay.

Results:

One hundred sixty-eight patients were included. Transient and persistent acute kidney injuries occurred in 24 and 17%, respectively. Cardiopulmonary bypass and aortic cross clamp duration, and incidence of cardiac arrest were greater among those with persistent kidney injury. Mortality was four times higher (41 versus 12%, p < 0.001) and mechanical ventilation duration 50 hours longer in persistent acute kidney injury patients (158 versus 107 hours; p < 0.001). In multivariable analysis, persistent acute kidney injury was not associated with mortality, duration of ventilation or length of stay. Severe persistent acute kidney injury was associated with a 59% increase in expected ventilation duration (aIRR:1.59, 95% CI:1.16, 2.18; p = 0.004).

Conclusions:

Future large studies are needed to determine if risk factors and outcomes change by delineating acute kidney injury into discrete timing phenotypes.

Keywords

Acute kidney injuryNorwood operationoutcomesneonataltransientpersistent
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 4 , April 2022 , pp. 564 - 571
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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