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Periods of low renal perfusion pressure are associated with acute kidney injury following paediatric cardiac surgery

Published online by Cambridge University Press:  16 May 2024

Jamie S. Penk Open the ORCID record for Jamie S. Penk [Opens in a new window] ,
Katja M. Gist ,
Matthew Barhight ,
Karl Migally ,
Santiago Borasino ,
Wendy F. Torres ,
Siyuan Dong ,
Bradley S. Marino  and
Catherine D. Krawczeski
Jamie S. Penk*
Affiliation:
Department of Pediatrics, Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Katja M. Gist
Affiliation:
Department of Pediatrics, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
Matthew Barhight
Affiliation:
Department of Pediatrics, Division of Critical Care, Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Karl Migally
Affiliation:
Department of Pediatrics, Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Santiago Borasino
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s of Alabama, Burmingham, AL, USA
Wendy F. Torres
Affiliation:
Department of Pediatrics, Division of Cardiology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
Siyuan Dong
Affiliation:
Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Chicago, IL, USA
Bradley S. Marino
Affiliation:
Department of Heart Vascular and Thoracic, Division of Cardiology and Cardiovascular Medicine, Cleveland Clinic Children’s, Cleveland, OH, USA
Catherine D. Krawczeski
Affiliation:
Department of Pediatrics, Division of Cardiology, Nationwide Children’s Hospital, Columbus, OH, USA
*
Corresponding author: J. S. Penk; Email: jpenk@luriechildrens.org
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Abstract

Introduction:

Acute kidney injury is associated with worse outcomes after cardiac surgery. The haemodynamic goals to ameliorate kidney injury are not clear. Low post-operative renal perfusion pressure has been associated with acute kidney injury in adults. Inadequate oxygen delivery may also cause kidney injury. This study evaluates pressure and oximetric haemodynamics after paediatric cardiac surgery and their association with acute kidney injury.

Materials and Methods:

Retrospective case–control study at a children’s hospital. Patients were < 6 months of age who underwent a Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery categories ≥ 3. Low renal perfusion pressure was time and depth below several tested thresholds. The primary outcome was serum creatine-defined acute kidney injury in the first 7 days.

Results:

Sixty-six patients (median age 8 days) were included. Acute kidney injury occurred in 36%. The time and depth of renal perfusion pressure < 42 mmHg in the first 24 hours was greater in acute kidney injury patients (94 versus 35 mmHg*minutes of low renal perfusion pressure/hour, p = 0.008). In the multivariable model, renal perfusion pressure < 42 mmHg was associated with acute kidney injury (aOR: 2.07, 95%CI: 1.25–3.82, p = 0.009). Mean arterial pressure, central venous pressure, and measures of inadequate oxygen delivery were not associated with acute kidney injury.

Conclusion:

Periods of low renal perfusion pressure (<42 mmHg) in the first 24 post-operative hours are associated with acute kidney injury. Renal perfusion pressure is a potential modifiable target that may mitigate the impact of acute kidney injury after paediatric cardiac surgery.

Keywords

Paediatric cardiac surgeryacute kidney injuryrenal perfusion pressurecardiac critical caremean arterial pressurecentral venous pressure

Information

Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 9 , September 2024 , pp. 1934 - 1939
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Copyright
© The Author(s), 2024. Published by Cambridge University Press

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