title: A comparison of the effect of aprotinin and ε-aminocaproic acid on renal function in children undergoing cardiac surgery.
abstract: OBJECTIVE
  To assess the incidence of renal injury among pediatric patients who received aprotinin while undergoing cardiac surgery compared with those who received ε-aminocaproic acid (EACA).
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  A single academic center.
  
  
  METHODS
  Pediatric cardiac patients who had cardiopulmonary bypass and received aprotinin or EACA.
  
  
  METHODS
  Patients undergoing pediatric cardiac surgery received aprotinin from 2005 to 2007 and EACA from 2008 to 2009.
  
  
  RESULTS
  The primary outcome was acute kidney injury (AKI) defined as serum Cr elevation at discharge more than 1.5 times the baseline value. Secondary outcomes included bleeding, blood transfusion, and the volume of chest tube drainage in the first 24 hours postoperatively. One hundred seventy-eight patients met inclusion criteria; 120 patients received aprotinin, and 58 patients received EACA. These 2 groups did not differ significantly in age, weight, or duration of cardiac bypass. Logistic regression analysis, adjusted for confounding variables (ie, baseline Cr, sex, age, CPB time, inotropic support and vasopressors), showed a higher odds of suffering AKI at discharge with the usage of aprotinin (odds ratio = 4.7; 95% confidence interval, 1.1-19.5; p = 0.03). The volume of the first 24 hours of chest tube drainage was not significantly different between groups, as well as packed red blood cells and cryoprecipitate units. However, fresh frozen plasma and platelets showed statistically significant differences with more transfusion in the EACA group.
  
  
  CONCLUSIONS
  In this retrospective study, the authors observed a higher odds of AKI for aprotinin usage compared with EACA, suggesting that the known concern for adults with adverse kidney effects with aprotinin is also appropriate for pediatric patients.
authors.affiliation: Department of Anesthesiology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10467, USA. gleyvi@montefiore.org
authors.forename: Galina
authors.initials: G
authors.lastname: Leyvi
authors.forename: Olivia
authors.initials: O
authors.lastname: Nelson
authors.forename: Adam
authors.initials: A
authors.lastname: Yedlin
authors.forename: Michelle
authors.initials: M
authors.lastname: Pasamba
authors.forename: Peter F
authors.initials: PF
authors.lastname: Belamarich
authors.forename: Singh
authors.initials: S
authors.lastname: Nair
authors.forename: Hillel W
authors.initials: HW
authors.lastname: Cohen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D000367:Age Factors; D015119:Aminocaproic Acid / Q000009:adverse effects*; D007611:Aprotinin / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D003401:Creatine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests / Q000379:methods; D008297:Male; D011183:Postoperative Complications / Q000097:blood / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007611:Aprotinin; D003401:Creatine; D015119:Aminocaproic Acid