title: Incidence, risk factors, and outcomes of acute kidney injury in adults undergoing surgery for congenital heart disease.
abstract: BACKGROUND
  Acute kidney injury after cardiac surgery is a frequent and serious complication among children with congenital heart disease (CHD) and adults with acquired heart disease; however, the significance of kidney injury in adults after congenital heart surgery is unknown. The primary objective of this study was to determine the incidence of acute kidney injury after surgery for adult CHD. Secondary objectives included determination of risk factors and associations with clinical outcomes.
  
  
  METHODS
  This single-centre, retrospective cohort study was performed in a quaternary cardiovascular ICU in a paediatric hospital including all consecutive patients ⩾18 years between 2010 and 2013.
  
  
  RESULTS
  Data from 118 patients with a median age of 29 years undergoing cardiac surgery were analysed. Using Kidney Disease: Improving Global Outcome creatinine criteria, 36% of patients developed kidney injury, with 5% being moderate to severe (stage 2/3). Among higher-complexity surgeries, incidence was 59%. Age ⩾35 years, preoperative left ventricular dysfunction, preoperative arrhythmia, longer bypass time, higher Risk Adjustment for Congenital Heart Surgery-1 category, and perioperative vancomycin use were significant risk factors for kidney injury development. In multivariable analysis, age ⩾35 years and vancomycin use were significant predictors. Those with kidney injury were more likely to have prolonged duration of mechanical ventilation and cardiovascular ICU stay in the univariable regression analysis.
  
  
  CONCLUSIONS
  We demonstrated that acute kidney injury is a frequent complication in adults after surgery for CHD and is associated with poor outcomes. Risk factors for development were identified but largely not modifiable. Further investigation within this cohort is necessary to better understand the problem of kidney injury.
authors.affiliation: 1Division of Cardiology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: David M
authors.identifier: http://orcid.org/0000-0003-3331-9280
authors.initials: DM
authors.lastname: Kwiatkowski
authors.affiliation: 1Division of Cardiology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Price
authors.affiliation: 1Division of Cardiology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: David M
authors.initials: DM
authors.lastname: Axelrod
authors.affiliation: 1Division of Cardiology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Anitra W
authors.initials: AW
authors.lastname: Romfh
authors.affiliation: 2Department of Pediatrics,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Han
authors.affiliation: 3Division of Nephrology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sutherland
authors.affiliation: 1Division of Cardiology,Lucile Packard Children's Hospital Stanford,Stanford University School of Medicine,Palo Alto,California,United States of America.
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Krawczeski
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: Adult CHD; acute kidney injury; cardiopulmonary bypass; cardiorenal interactions