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06-12-2023 | Acute Kidney Injury | Original Article

Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON

Authors: Denise C. Hasson, Jeffrey A. Alten, Rebecca A. Bertrandt, Huaiyu Zang, David T. Selewski, Garrett Reichle, David K. Bailly, Catherine D. Krawczeski, David S. Winlaw, Stuart L. Goldstein, Katja M. Gist, on behalf of the Neonatal, Pediatric Heart, Renal Outcomes Network (NEPHRON) Investigators

Published in: Pediatric Nephrology | Issue 5/2024

Abstract

Background

Cardiac surgery-associated acute kidney injury (CS-AKI) is common, but its impact on clinical outcomes is variable. Parsing AKI into sub-phenotype(s) and integrating pathologic positive cumulative fluid balance (CFB) may better inform prognosis. We sought to determine whether durational sub-phenotyping of CS-AKI with CFB strengthens association with outcomes among neonates undergoing the Norwood procedure.

Methods

Multicenter, retrospective cohort study from the Neonatal and Pediatric Heart and Renal Outcomes Network. Transient CS-AKI: present only on post-operative day (POD) 1 and/or 2; persistent CS-AKI: continued after POD 2. CFB was evaluated per day and peak CFB during the first 7 postoperative days. Primary and secondary outcomes were mortality, respiratory support-free and hospital-free days (at 28, 60 days, respectively). The primary predictor was persistent CS-AKI, defined by modified neonatal Kidney Disease: Improving Global Outcomes criteria.

Results

CS-AKI occurred in 59% (205/347) neonates: 36.6% (127/347) transient and 22.5% (78/347) persistent; CFB > 10% occurred in 18.7% (65/347). Patients with either persistent CS-AKI or peak CFB > 10% had higher mortality. Combined persistent CS-AKI with peak CFB > 10% (n = 21) associated with increased mortality (aOR: 7.8, 95% CI: 1.4, 45.5; p = 0.02), decreased respiratory support-free (predicted mean 12 vs. 19; p < 0.001) and hospital-free days (17 vs. 29; p = 0.048) compared to those with neither.

Conclusions

The combination of persistent CS-AKI and peak CFB > 10% after the Norwood procedure is associated with mortality and hospital resource utilization. Prospective studies targeting intra- and postoperative CS-AKI risk factors and reducing CFB have the potential to improve outcomes.

Graphical abstract

Available only for authorised users

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Title: Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON
Authors: Denise C. Hasson
Jeffrey A. Alten
Rebecca A. Bertrandt
Huaiyu Zang
David T. Selewski
Garrett Reichle
David K. Bailly
Catherine D. Krawczeski
David S. Winlaw
Stuart L. Goldstein
Katja M. Gist
on behalf of the Neonatal, Pediatric Heart, Renal Outcomes Network (NEPHRON) Investigators
Publication date: 06-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Acute Kidney Injury
Acute Kidney Injury
Heart Surgery
Heart Surgery
Published in: Pediatric Nephrology / Issue 5/2024
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-023-06235-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Graphical abstract

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