title: Comparison of Intraoperative Aminophylline Versus Furosemide in Treatment of Oliguria During Pediatric Cardiac Surgery.
abstract: To determine if intraoperative aminophylline was superior to furosemide to prevent or attenuate postoperative cardiac surgery-associated acute kidney injury.
  
  
  
  Single-center, historical control, retrospective cohort study.
  
  
  
  PICU, university-affiliated children's hospital.
  
  
  
  Children with congenital heart disease in PICU who received furosemide or aminophylline to treat intraoperative oliguria.
  
  
  
  Intraoperative oliguria was treated either with furosemide (September 2007 to February 2012) or with aminophylline (February 2012 to June 2013). The postoperative 48 hours renal outcomes of the aminophylline group were compared with the furosemide group. The primary outcomes were acute kidney injury and renal replacement therapy use at 48 hours postoperatively. Surgical complexity was accounted for by the use of Risk Adjustment for Congenital Heart Surgery-1 score.
  
  
  
  The study involves 69 months of observation. There were 200 cases younger than 21 years old reviewed for this study. Eighty-five cases (42.5%) developed acute kidney injury. The aminophylline group patients produced significantly more urine (mL/kg/hr) during the first 8 hours postoperatively than furosemide patients (5.1 vs 3.4 mL/kg/hr; p = 0.01). The urine output at 48 hours postoperatively was similar between the two groups. There was no difference in acute kidney injury incidence at 48 hours between the aminophylline and furosemide groups (38% vs 47%, respectively; p = 0.29). Fewer aminophylline group subjects required renal replacement therapy compared to the furosemide group subjects (n = 1 vs 7, respectively; p = 0.03). In the multi-variant predictive model, intraoperative aminophylline infusion was noted as a negative predictive factor for renal replacement therapy, but not for cardiac surgery-associated acute kidney injury.
  
  
  
  The intraoperative use of aminophylline was more effective than furosemide in reversal of oliguria in the early postoperative period. There were less renal replacement therapy-requiring acute kidney injury in children in the aminophylline group. Future prospective studies of intraoperative aminophylline to prevent cardiac surgery-associated acute kidney injury may be warranted.
authors.affiliation: 1Division of Pediatric Nephrology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV 2Division of Pediatric Cardiothoracic Anesthesiology, Department of Anesthesiology, West Virginia University School of Medicine, Morgantown, WV. 3Department of Pediatrics, Division of Pediatric Intensive Care Unit, West Virginia University School of Medicine, Morgantown, WV. 4Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV. 5Division of Pediatric Cardiothoracic Surgery, Department of Surgery, West Virginia University School of Medicine, Morgantown, WV. 6Division of Pediatric Cardiology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV.
authors.forename: Ali Mirza
authors.initials: AM
authors.lastname: Onder
authors.forename: David
authors.initials: D
authors.lastname: Rosen
authors.forename: Charles
authors.initials: C
authors.lastname: Mullett
authors.forename: Lesley
authors.initials: L
authors.lastname: Cottrell
authors.forename: Sherry
authors.initials: S
authors.lastname: Kanosky
authors.forename: Oulimata Kane
authors.initials: OK
authors.lastname: Grossman
authors.forename: Hafiz Imran
authors.initials: HI
authors.lastname: Iqbal
authors.forename: Eric
authors.initials: E
authors.lastname: Seachrist
authors.forename: Lennie
authors.initials: L
authors.lastname: Samsell
authors.forename: Kelly
authors.initials: K
authors.lastname: Gustafson
authors.forename: Larry
authors.initials: L
authors.lastname: Rhodes
authors.forename: Robert
authors.initials: R
authors.lastname: Gustafson
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D000293:Adolescent; D000628:Aminophylline / Q000627:therapeutic use*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005665:Furosemide / Q000627:therapeutic use*; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000188:drug therapy*; D008297:Male; D009846:Oliguria / Q000188:drug therapy* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004232:Diuretics; D000628:Aminophylline; D005665:Furosemide