title: Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study.
abstract: OBJECTIVE
  To determine the incidence, severity, and risk factors of acute kidney injury in children undergoing cardiac surgery for congenital heart defects.
  
  
  METHODS
  Prospective observational multicenter cohort study.
  
  
  METHODS
  Three pediatric intensive care units at academic centers.
  
  
  METHODS
  Three hundred eleven children between the ages of 1 month and 18 yrs undergoing pediatric cardiac surgery.
  
  
  METHODS
  None.
  
  
  RESULTS
  Acute kidney injury was defined as a ≥50% increase in serum creatinine from the preoperative value. Secondary outcomes were length of mechanical ventilation, length of intensive care unit and hospital stays, acute dialysis, and in-hospital mortality. The cohort had an average age of 3.8 yrs and was 45% women and mostly white (82%). One-third had prior cardiothoracic surgery, 91% of the surgeries were elective, and almost all patients required cardiopulmonary bypass. Acute kidney injury occurred in 42% (130 patients) within 3 days after surgery. Children ≥2 yrs old and <13 yrs old had a 72% lower likelihood of acute kidney injury (adjusted odds ratio: 0.28, 95% confidence interval: 0.16, 0.48), and patients 13 yrs and older had 70% lower likelihood of acute kidney injury (adjusted odds ratio: 0.30, 95% confidence interval: 0.10, 0.88) compared to patients <2 yrs old. Longer cardiopulmonary bypass time was linearly and independently associated with acute kidney injury. The development of acute kidney injury was independently associated with prolonged ventilation and with increased length of hospital stay.
  
  
  CONCLUSIONS
  Acute kidney injury is common after pediatric cardiac surgery and is associated with prolonged mechanical ventilation and increased hospital stay. Cardiopulmonary bypass time and age were independently associated with acute kidney injury risk. Cardiopulmonary bypass time may be a marker for case complexity.
authors.affiliation: Division of Pediatric Critical Care, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Heather
authors.initials: H
authors.lastname: Thiessen-Philbrook
authors.forename: Steven G
authors.initials: SG
authors.lastname: Coca
authors.forename: Richard W
authors.initials: RW
authors.lastname: Kim
authors.forename: Chirag R
authors.initials: CR
authors.lastname: Parikh
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome