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First-stage palliation strategy for univentricular heart disease may impact risk for acute kidney injury

Published online by Cambridge University Press:  11 September 2017

Bryan H. Goldstein ,
Stuart L. Goldstein ,
Prasad Devarajan ,
Farhan Zafar ,
David M. Kwiatkowski Open the ORCID record for David M. Kwiatkowski [Opens in a new window] ,
Bradley S. Marino ,
David L. S. Morales ,
Catherine D. Krawczeski  and
David S. Cooper
Bryan H. Goldstein*
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Stuart L. Goldstein
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Prasad Devarajan
Affiliation:
Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Farhan Zafar
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
David M. Kwiatkowski
Affiliation:
Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, United States of America
Bradley S. Marino
Affiliation:
Division of Cardiology, Northwestern University Feinberg School of Medicine and Lurie Children’s Hospital, Chicago, Illinois, United States of America
David L. S. Morales
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Catherine D. Krawczeski
Affiliation:
Division of Cardiology, Stanford University School of Medicine, Palo Alto, California, United States of America
David S. Cooper
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
*
Correspondence to: B. H. Goldstein, MD, The Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH 45229, United States of America. Tel: 513 636 7072; Fax: 513 636 2410; E-mail: bryan.goldstein@cchmc.org
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Abstract

Objective

Norwood palliation for patients with single ventricle heart disease is associated with a significant risk for acute kidney injury, which portends a worse prognosis. We sought to investigate the impact of hybrid stage I palliation (Hybrid) on acute kidney injury risk.

Design

This study is a single-centre prospective case–control study of seven consecutive neonates with single ventricle undergoing Hybrid palliation. Levels of serum creatinine and four novel urinary biomarkers, namely neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty acid-binding protein, and kidney injury molecule-1, were obtained before and after palliation. Acute kidney injury was defined as a ⩾50% increase in serum creatinine within 48 hours after the procedure. Data were compared with a contemporary cohort of 12 neonates with single ventricle who underwent Norwood palliation.

Results

Patients who underwent Hybrid were more likely to be high-risk candidates (86 versus 25%, p=0.01) compared with those who underwent Norwood. Despite similar preoperative serum creatinine levels, there was a trend towards higher levels of postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47, 0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in the Norwood cohort. Preoperative neutrophil gelatinase-associated lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect models demonstrated Hybrid palliation to be a protective factor against increased postoperative levels of neutrophil gelatinase-associated lipocalin (estimate −1.8 [−3.0, −9.0], p<0.001) and liver fatty acid-binding protein (−49.3 [−89.7, −8.8], p=0.018).

Conclusions

In this single-centre case–control study, postoperative acute kidney injury risk did not differ significantly by single ventricle stage I treatment strategy; however, postoperative elevation in novel urinary biomarkers, consistent with subclinical kidney injury, was encountered in the Norwood cohort but not in the Hybrid cohort.

Keywords

Acute kidney injuryhypoplastic left heart syndromeNorwood procedureHybrid procedureCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 93 - 100
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Copyright
© Cambridge University Press 2017 

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