title: Cardiac catheterization and postoperative acute kidney failure in congenital heart pediatric patients.
abstract: BACKGROUND
  Acute renal failure (ARF) is a severe complication of cardiac operations in pediatric patients. Angiography with the exposure to contrast media is a risk factor for ARF. In the present study, we explored the association between timing of angiography, dose of contrast media, and the incidence of ARF after cardiac operations in pediatric patients.
  
  
  METHODS
  We performed a retrospective analysis of prospectively collected data. Angiographic data and other covariates were collected in 277 patients aged ≤12 years receiving angiography and cardiac operations during the same hospital stay. Renal outcome was assessed according to the pediatric Risk, Injury, Failure, Loss of function, End stage score (pRIFLE).
  
  
  RESULTS
  One hundred seventy-seven (64%) patients suffered some degree of postoperative renal dysfunction, and 55 (20%) had ARF (pRIFLE stage Failure). Patients with ARF received a significantly (P < 0.001) larger dose of iodine contrast media (4.6 ± 2.6 g/kg) with respect to the other patients (2.8 ± 2.2 g/kg), with a relative risk increase for ARF of 31% per each incremental iodine dose of 1 g/kg at the univariate analysis. A multivariable risk model demonstrated that the risk for ARF is 20 times higher in patients aged younger than 2 years and 3 times higher in case of postoperative low cardiac output. Within this model, the iodine dose on angiography is confirmed as an independent risk factor for ARF, with a relative risk increase for ARF of 16% per each incremental iodine dose of 1 g/kg.
  
  
  CONCLUSIONS
  Angiography before cardiac surgery is an important risk factor for ARF in pediatric patients. Being a modifiable risk factor, the contrast media dose should be limited to the lowest possible value, avoiding large doses of iodine which, together with other factors (age and postoperative low cardiac output), concur in the determinism of postoperative ARF.
authors.affiliation: Departments of Cardiothoracic-Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Policlinico San Donato Via Morandi 30, 20097 San Donato Milanese, Milan, Italy. paolo_bianchi@icloud.com
authors.forename: Paolo
authors.initials: P
authors.lastname: Bianchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Carboni
authors.forename: Giorgia
authors.initials: G
authors.lastname: Pesce
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Isgrò
authors.forename: Concetta
authors.initials: C
authors.lastname: Carlucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.forename: Marco
authors.initials: M
authors.lastname: Ranucci
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D000367:Age Factors; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000401:mortality; D002303:Cardiac Output, Low / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D017023:Coronary Angiography / Q000009:adverse effects* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007479:Iopamidol / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol