title: Acute kidney injury after Fontan completion: Risk factors and outcomes.
abstract: OBJECTIVE
  Acute kidney injury (AKI) is a predictor of outcomes in heterogeneous populations of children undergoing cardiac surgery. We investigated its causes and consequences in a cohort undergoing Fontan completion, hypothesizing that central venous pressure is independently associated with development of AKI.
  
  
  METHODS
  In this retrospective cohort study of patients undergoing Fontan (n = 211), univariable and multivariable analyses identified factors associated with AKI within 3 days of surgery. Secondary analyses identified factors associated with hospital length of stay, and examined effects of perioperative kidney injury on follow-up renal function.
  
  
  RESULTS
  Acute kidney injury occurred in 42% of cases (n = 89), with the following independent risk factors: mean renal perfusion (mean arterial minus central venous) pressure on postoperative day zero (per mm Hg; adjusted odds ratio [AOR] 0.83; P < .001); preoperative atrioventricular valve regurgitation > mild (AOR 6.78; P = .02); bypass time (per 10 minutes, AOR 1.08; P = .04); peak inotrope score on postoperative day zero (per point, AOR 1.17; P < .001); and preoperative pulmonary vascular resistance (per Wood unit, AOR 1.69; P = .04). Central venous pressure was not independently associated with AKI. Moderate and severe (but not mild) AKI were independently associated with prolonged hospital length of stay (adjusted hazard ratios, 0.56; P = .004, and .41; P = .006, respectively). Perioperative injury was not associated with longer-term renal dysfunction.
  
  
  CONCLUSIONS
  Acute kidney injury is common after Fontan completion and has several potentially modifiable risk factors. Moderate-to-severe injury is associated with longer hospital length of stay but not with renal dysfunction at follow-up.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Esch
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Salvin
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Thiagarajan
authors.affiliation: Department of Cardiovascular Surgery, Harvard Medical School, Boston, Mass.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Del Nido
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Boston, Mass. Electronic address: Satish.Rajagopal@cardio.chboston.org.
authors.forename: Satish K
authors.initials: SK
authors.lastname: Rajagopal
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Pediatrics; acute kidney injury; congenital heart disease; fontan