Risk Factors Associated with Acute Kidney Injury in Neonates and Infants Following Open Heart Surgery

Abstract

BACKGROUND: The complexity of surgical cardiac procedures is on the rise, resulting in prolonged cardiopulmonary bypass time and stay in the intensive care unit. One major complication of cardiac surgery is acute kidney injury. The aim of this study is to investigate the incidence and risk factors associated with acute kidney injury following open heart surgery. METHODOLOGY: This is a retrospective cohort study that involved chart review of patients <1 year old who underwent open heart surgery from January 2012 to December 2017 in a tertiary cardiovascular referral center. Preoperative characteristics included age, gender, weight, cardiac diagnosis, baseline serum creatinine, history of mechanical ventilation and cardiac catheterization and pre operative medications given. Intra-operative characteristics included cardiopulmonary bypass and cross clamp time of cardiac surgery, and degree of hypothermia . Post operatively, urine output, systolic blood pressure, mean arterial pressure, highest serum creatinine and blood urea nitrogen were recorded. RESULTS: Sixty one (61) patients were included in the study. Nine patients (15%) developed post-operative acute kidney injury, two of which underwent peritoneal dialysis. Lowest systolic blood pressure and lowest mean arterial pressure were noted to be significant in the development of acute kidney injury with odds ratio of 0.95 (p=0.049) and 0.93 (p=0.025), respectively. The duration of mechanical ventilation was also significantly increased in patients who developed acute kidney injury (p=0.028). CONCLUSION: Lowest systolic blood pressure and lowest mean arterial pressure are significant risk factors for acute kidney injury in neonates and infants following open heart surgery. KEYWORDS: acute kidney injury, acute renal failure, cardiac surgery in infants, congenital heart disease, cardiopulmonary bypass time