Acute Kidney Injury After Paediatric Cardiac Surgery with Extracorporeal Circulation: Incidence and Risk Factors? Prospective Observational Study in A Cardiac Centre In A Developing Country

Abstract

Introduction: Acute kidney injury is a clinico-biological syndrome that ranges in severity from Kidney attack to failure. The aim of this study was to determine the incidence and risk factors of AKI after paediatric cardiac surgery with extracorporeal circulation. Methods: Prospective observational study, conducted over a period of 4 months at the cardiac centre of the CHU of Fann. The diagnosis of AKI was based on the modified RIFLE criteria for paediatrics. Results: Our work involved 40 patients with a male predominance (sex ratio 1.8) and an average age of 7.2 years. We noted 02 types of surgery: congenital surgery (80%), valvular surgery (20%). All patients underwent scheduled surgery with a mean preoperative GFR of 130.2 ml/Kg/1.73 m2. The mean duration of extracorporeal circulation was 107.7 min. Postoperatively, 82.5% were placed on sympathomimetics, 12.5% had severe left ventricular systolic dysfunction, 27.5% had severe right ventricular systolic dysfunction and one quarter of the patients received a postoperative transfusion. The incidence of AKI was 30% with: 20% at risk, 7.5% with damage and only one patient in failure. Right ventricular systolic dysfunction and postoperative transfusion were the main risk factors. Mortality in our series was 10% and the dependence on AKI was significant (p=0.038). Conclusion: The epidemiology of AKI after paediatric cardiac surgery depends on the definition used. The incidence is highly variable and depends on the epidemiological, intraoperative and postoperative characteristics of the patients.