title: Incidence, risk factors and clinical outcomes for acute kidney injury after aortic arch repair in paediatric patients.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is common after paediatric cardiac surgery and associated with increased morbidity and mortality. Aortic arch surgery may be an independent risk factor for AKI because of circulatory arrest below the descending thoracic artery during anastomosis. We investigated the surgical outcomes associated with AKI after aortic arch repair in paediatric patients.
  
  
  METHODS
  We retrospectively analysed 120 paediatric patients who underwent aortic arch repair between 2003 and 2012. AKI was defined according to the paediatric-modified risk, injury, failure, loss and end-stage kidney disease criteria. The incidence, clinical outcomes and risk factors for AKI were analysed.
  
  
  RESULTS
  Aortic arch repair was performed for coarctation of aorta in 97 patients and interrupted aortic arch in 23 patients. The median age and body weight at the time of surgery were 16.5 days and 3.3 kg, respectively. The mean duration of the follow-up was 3.9 years. AKI developed in 42 patients (36.8%) and peritoneal dialysis (PD) was applied in 20 patients (16.7%). The recovery of renal function began a mean of 3.8 days after conservative management, and full recovery occurred a mean of 6.7 days after conservative management. A lower body weight (<3.0 kg) (odds ratio [OR]: 7.569, P = 0.009) and the absence of prerenal impairment (OR: 9.876, P = 0.041) were shown to be independent risk factors. Patients who required PD had prolonged intensive care unit and hospital stays (P = 0.002 and P = 0.003).
  
  
  CONCLUSIONS
  AKI is common in low-birth-weight patients after aortic arch repair surgery. However, patients recover from AKI after conservative management. Requiring PD increases the morbidity associated with AKI.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Woo Sung
authors.initials: WS
authors.lastname: Jang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea woonghan@snu.ac.kr.
authors.forename: Woong-Han
authors.initials: WH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Children's Hospital, Pusan National University College of Medicine, Gyeongnam, South Korea.
authors.forename: Kwangho
authors.initials: K
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: JinHae
authors.initials: J
authors.lastname: Nam
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Joon Chul
authors.initials: JC
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Bo Sang
authors.initials: BS
authors.lastname: Kwon
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Gi Beom
authors.initials: GB
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Hee Gyung
authors.initials: HG
authors.lastname: Kang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jeong Ryul
authors.initials: JR
authors.lastname: Lee
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Yong Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D000704:Analysis of Variance; D001013:Aorta, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007677:Kidney Function Tests; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Acute kidney injury; Aortic arch surgery; Congenital heart disease; Prognosis