Top

Published in:

01-09-2017 | Educational Review

Acute kidney injury and fluid overload in infants and children after cardiac surgery

Published in: Pediatric Nephrology | Issue 9/2017

Abstract

Acute kidney injury is a common and serious complication after congenital heart surgery, particularly among infants. This comorbidity has been independently associated with adverse outcomes including an increase in mortality. Postoperative acute kidney injury has a complex pathophysiology with many risk factors, and therefore no single medication or therapy has been demonstrated to be effective for treatment or prevention. However, it has been established that the associated fluid overload is one of the major determinants of morbidity, particularly in infants after cardiac surgery. Therefore, in the absence of an intervention to prevent acute kidney injury, much of the effort to improve outcomes has focused on treating and preventing fluid overload. Early renal replacement therapy, often in the form of peritoneal dialysis, has been shown to be safe and beneficial in infants with oliguria after heart surgery. As understanding of the pathophysiology of acute kidney injury and the ability to confidently diagnose it earlier continues to evolve, it is likely that novel preventative and therapeutic interventions will be available in the future.

Available only for authorised users

Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, Kim RW, Parikh CR (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery—a prospective multicenter study. Crit Care Med 39:1493CrossRefPubMedPubMedCentral

Blinder JJ, Goldstein SL, Lee V-V, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374CrossRefPubMed

Morgan CJ, Zappitelli M, Robertson CM, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM, Western Canadian Complex Pediatric Therapies Follow-Up Group (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162:120–127.e1CrossRefPubMed

Williams DM, Sreedhar SS, Mickell JJ, Chan JC (2002) Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med 156:893–900CrossRefPubMed

Krawczeski CD, Goldstein SL, Woo JG, Wang Y, Piyaphanee N, Ma Q, Bennett M, Devarajan P (2011) Temporal relationship and predictive value of urinary acute kidney injury biomarkers after pediatric cardiopulmonary bypass. J Am Coll Cardiol 58:2301–2309CrossRefPubMedPubMedCentral

Machado MN, Nakazone MA, Maia LN (2014) Acute kidney injury based on KDIGO (Kidney Disease Improving Global Outcomes) criteria in patients with elevated baseline serum creatinine undergoing cardiac surgery. Rev Bras Cir Cardiovasc 29:299–307PubMedPubMedCentral

Novis BK, Roizen MF, Aronson S, Thisted RA (1994) Association of preoperative risk factors with postoperative acute renal failure. Anesth Analg 78:143–149CrossRefPubMed

Kellum JA, Lameire N (2013) Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 17:204CrossRefPubMedPubMedCentral

Akcan-Arikan A, Zappitelli M, Loftis L, Washburn K, Jefferson L, Goldstein S (2007) Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 71:1028–1035CrossRefPubMed

10.

Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11:R31CrossRefPubMedPubMedCentral

11.

Lex DJ, Tóth R, Cserép Z, Alexander SI, Breuer T, Sápi E, Szatmári A, Székely E, Gál J, Székely A (2014) A comparison of the systems for the identification of postoperative acute kidney injury in pediatric cardiac patients. Ann Thorac Surg 97:202–210CrossRefPubMed

12.

Kaddourah A, Basu RK, Bagshaw SM, Goldstein SL (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20CrossRefPubMed

13.

Zappitelli M, Bernier P-L, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O (2009) A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 76:885–892CrossRefPubMed

14.

Hassinger AB, Backer CL, Lane JC, Haymond S, Wang D, Wald EL (2012) Predictive power of serum cystatin C to detect acute kidney injury and pediatric-modified RIFLE class in children undergoing cardiac surgery. Pediatr Crit Care Med 13:435–440CrossRefPubMed

15.

Spahillari A, Parikh CR, Sint K, Koyner JL, Patel UD, Edelstein CL, Passik CS, Thiessen-Philbrook H, Swaminathan M, Shlipak MG (2012) Serum cystatin C- versus creatinine-based definitions of acute kidney injury following cardiac surgery: a prospective cohort study. Am J Kidney Dis 60:922–929CrossRefPubMedPubMedCentral

16.

Dharnidharka VR, Kwon C, Stevens G (2002) Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 40:221–226CrossRefPubMed

17.

Meersch M, Schmidt C, Van Aken H, Martens S, Rossaint J, Singbartl K, Görlich D, Kellum JA, Zarbock A (2014) Urinary TIMP-2 and IGFBP7 as early biomarkers of acute kidney injury and renal recovery following cardiac surgery. PLoS One 9:e93460CrossRefPubMedPubMedCentral

18.

Meersch M, Schmidt C, Van Aken H, Rossaint J, Görlich D, Stege D, Malec E, Januszewska K, Zarbock A (2014) Validation of cell-cycle arrest biomarkers for acute kidney injury after pediatric cardiac surgery. PLoS One 9:e110865CrossRefPubMedPubMedCentral

19.

Kwiatkowski DM, Goldstein SL, Krawczeski CD (2012) Biomarkers of acute kidney injury in pediatric cardiac patients. Biomarkers 6:273–282CrossRef

20.

Chawla LS, Kellum JA (2012) Acute kidney injury in 2011: biomarkers are transforming our understanding of AKI. Nat Rev Nephrol 8:68–70CrossRefPubMed

21.

Vanmassenhove J, Vanholder R, Nagler E, Van Biesen W (2013) Urinary and serum biomarkers for the diagnosis of acute kidney injury: an in-depth review of the literature. Nephrol Dial Transplant 28:254–273CrossRefPubMed

22.

Basu RK, Wong HR, Krawczeski CD, Wheeler DS, Manning PB, Chawla LS, Devarajan P, Goldstein SL (2014) Combining functional and tubular damage biomarkers improves diagnostic precision for acute kidney injury after cardiac surgery. J Am Coll Cardiol 64:2753–2762CrossRefPubMedPubMedCentral

23.

Abuelo JG (2007) Normotensive ischemic acute renal failure. N Engl J Med 357:797–805CrossRefPubMed

24.

Devarajan P (2006) Update on mechanisms of ischemic acute kidney injury. J Am Soc Nephrol 17:1503–1520CrossRefPubMed

25.

Rosner MH, Okusa MD (2006) Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 1:19–32CrossRefPubMed

26.

Okusa MD (2002) The inflammatory cascade in acute ischemic renal failure. Nephron 90:133–138CrossRefPubMed

27.

Algaze CA, Koth AM, Faberowski LW, Hanley FL, Krawczeski CD, Axelrod DM (2017) Acute kidney injury in patients undergoing the extracardiac Fontan operation with and without the use of cardiopulmonary bypass. Pediatr Crit Care Med 18:34–43CrossRefPubMed

28.

Stafford-Smith M, Podgoreanu M, Swaminathan M, Phillips-Bute B, Mathew JP, Hauser EH, Winn MP, Milano C, Nielsen DM, Smith M (2005) Association of genetic polymorphisms with risk of renal injury after coronary bypass graft surgery. Am J Kidney Dis 45:519–530CrossRefPubMed

29.

Cardinal-Fernández P, Ferruelo A, Martín-Pellicer A, Nin N, Esteban A, Lorente J (2012) Genetic determinants of acute renal damage risk and prognosis: a systematic review. Med Intensiva (English Edition) 36:626–633CrossRef

30.

Lassnigg A, Schmid ER, Hiesmayr M, Falk C, Druml W, Bauer P, Schmidlin D (2008) Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure? Crit Care Med 36:1129–1137CrossRefPubMed

31.

Cooper DS, Claes D, Goldstein SL, Menon S, Bennett M, Ma Q, Krawczeski C (2013) Novel urinary biomarkers remain elevated years after acute kidney injury following cardiac surgery in children. J Am Coll Cardiol 61:E438CrossRef

32.

Nichols DG, Greeley WJ, Lappe DG, Ungerleider RM, Cameron DE, Spevak PJ, Wetzel RC (2006) Critical heart disease in infants and children. Elsevier Health Science, Amsterdam, pp 113–130

33.

Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL (2010) Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 55:316–325CrossRefPubMed

34.

Hassinger AB, Wald EL, Goodman DM (2014) Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med 15:131–138CrossRefPubMed

35.

Wilder NS, Yu S, Donohue JE, Goldberg CS, Blatt NB (2016) Fluid overload is associated with late poor outcomes in neonates following cardiac surgery. Pediatr Crit Care Med 17:420–427CrossRefPubMedPubMedCentral

36.

Costello JM, Thiagarajan RR, Dionne RE, Allan CK, Booth KL, Burmester M, Wessel DL, Laussen PC (2006) Initial experience with fenoldopam after cardiac surgery in neonates with an insufficient response to conventional diuretics. Pediatr Crit Care Med 7:28–33CrossRefPubMed

37.

Axelrod DM, Anglemyer AT, Sherman-Levine SF, Zhu A, Grimm PC, Roth SJ, Sutherland SM (2014) Initial experience using aminophylline to improve renal dysfunction in the pediatric cardiovascular ICU. Pediatr Crit Care Med 15:21–27CrossRefPubMed

38.

Axelrod DM, Sutherland SM, Anglemyer A, Grimm PC, Roth SJ (2016) A double-blinded, randomized, placebo-controlled clinical trial of aminophylline to prevent acute kidney injury in children following congenital heart surgery with cardiopulmonary bypass. Pediatr Crit Care Med 17:135–143CrossRefPubMedPubMedCentral

39.

Ricci Z, Stazi GV, Di Chiara L, Morelli S, Vitale V, Giorni C, Ronco C, Picardo S (2008) Fenoldopam in newborn patients undergoing cardiopulmonary bypass: controlled clinical trial. Interact Cardiovasc Thorac Surg 7:1049–1053CrossRefPubMed

40.

Costello JM, Masterson CD, Allan CK, Gauvreau K, Newburger JW, McGowan FX, Wessel DL, Mayer JE, Salvin JW, Dionne RE (2014) Impact of empiric nesiritide or milrinone infusion on early postoperative recovery following Fontan surgery: a randomized, double-blind, placebo-controlled trial. Circ Heart Fail 7:596–604CrossRefPubMed

41.

Sampath S, Moran JL, Graham PL, Rockliff S, Bersten AD, Abrams KR (2007) The efficacy of loop diuretics in acute renal failure: assessment using Bayesian evidence synthesis techniques. Crit Care Med 35:2516–2524CrossRefPubMed

42.

Mehta RL, Pascual MT, Soroko S, Chertow GM, Group PS (2002) Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA 288:2547–2553CrossRefPubMed

43.

Van der Vorst MM, Kist JE, van der Heijden AJ, Burggraaf J (2006) Diuretics in pediatrics. Pediatr Drugs 8:245–264CrossRef

44.

Madenci AL, Stoffan AP, Rajagopal SK, Blinder JJ, Emani SM, Thiagarajan RR, Weldon CB (2013) Factors associated with survival in patients who undergo peritoneal dialysis catheter placement following cardiac surgery. J Pediatr Surg 48:1269–1276CrossRefPubMed

45.

Madenci AL, Thiagarajan RR, Stoffan AP, Emani SM, Rajagopal SK, Weldon CB (2013) Characterizing peritoneal dialysis catheter use in pediatric patients after cardiac surgery. J Thorac Cardiovasc Surg 146:334–338CrossRefPubMed

46.

Bojan M, Gioanni S, Vouhé PR, Journois D, Pouard P (2012) Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality. Kidney Int 82:474–481CrossRefPubMed

47.

Kwiatkowski DM, Menon S, Krawczeski CD, Goldstein SL, Morales DL, Phillips A, Manning PB, Eghtesady P, Wang Y, Nelson DP (2015) Improved outcomes with peritoneal dialysis catheter placement after cardiopulmonary bypass in infants. J Thorac Cardiovasc Surg 149:230–236CrossRefPubMed

48.

Sasser WC, Dabal RJ, Askenazi DJ, Borasino S, Moellinger AB, Kirklin JK, Alten JA (2014) Prophylactic peritoneal dialysis following cardiopulmonary bypass in children is associated with decreased inflammation and improved clinical outcomes. Congenit Heart Dis 9:106–115CrossRefPubMed

49.

Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, Bunchman TE, Baker C, Mottes T, Mcafee N (2005) Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 67:653–658CrossRefPubMed

50.

Stromberg D, Fraser CD Jr, Sorof JM, Drescher K, Feltes TF (1997) Peritoneal dialysis. An adjunct to pediatric postcardiotomy fluid management. Tex Heart Inst J 24:269PubMedPubMedCentral

51.

Alkan T, Akçevin A, Türkoglu H, Paker T, Sasmazel A, Bayer V, Ersoy C, Askn D, Aytaç A (2006) Postoperative prophylactic peritoneal dialysis in neonates and infants after complex congenital cardiac surgery. ASAIO J 52:693–697CrossRefPubMed

52.

Chien J-C, Hwang B-T, Weng Z-C, Meng LC-C, Lee P-C (2009) Peritoneal dialysis in infants and children after open heart surgery. Pediatr Neonatol 50:275–279CrossRefPubMed

53.

Averbuch N, Birk E, Frenkel G, Gogia O, Shulman OM, Bruckheimer E, Nachum E, Amir G (2014) Percutaneous intraperitoneal catheters in neonates following open heart surgery. J Intensive Care Med 29:160–164CrossRefPubMed

54.

Kwiatkowski DM, Goldstein SL, Cooper DS, Nelson DP, Morales DS, Krawczeski CD (2017) Peritoneal dialysis vs furosemide for prevention of fluid overload in infants after cardiac surgery: a randomized clinical trial. JAMA Pediatr. doi:10.1001/jamapediatrics.2016.4538 PubMed

55.

Riley AA, Jefferies JL, Nelson DP, Bennett MR, Blinder JJ, Ma Q, Devarajan P, Goldstein SL (2014) Peritoneal dialysis does not adversely affect kidney function recovery after congenital heart surgery. Int J Artif Organs 37:39–47CrossRefPubMedPubMedCentral

56.

Fleming GM, Askenazi DJ, Bridges BC, Cooper DS, Paden ML, Selewski DT, Zappitelli M (2012) A multicenter international survey of renal supportive therapy during ECMO: the Kidney Intervention During Extracorporeal Membrane Oxygenation (KIDMO) group. ASAIO J 58:407–414CrossRefPubMedPubMedCentral

Title: Acute kidney injury and fluid overload in infants and children after cardiac surgery
Publication date: 01-09-2017
Published in: Pediatric Nephrology / Issue 9/2017
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-017-3643-2

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Acute kidney injury and fluid overload in infants and children after cardiac surgery

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2017

Renal findings in patients with Mulibrey nanism

Response to “How best to quantify and express the levels of substances in the urine?”

Effect of the timing of dialysis initiation on left ventricular hypertrophy and ınflammation in pediatric patients

How best to quantify and express the levels of substances in the urine?

Uncommon cause of fever in a pediatric kidney transplant recipient: Questions

Focal segmental glomerulosclerosis and medullary nephrocalcinosis in children with ADCK4 mutations