Abstract:
Introduction. Acute kidney injury (AKI) is the most common and most serious complication
following heart surgery.
Aim of the study. To determine the prevalence of, and risk factors for, AKI following pediatric
cardiac surgery.
Materials and methods. We retrospectively analyzed 203 patients aged ≤18 years who
underwent cardiac surgery for congenital heart defects; by RACHS-1 category, 41 patients (43%)
had an operative risk score ≥3. AKI was defined and classified using the pediatric pRIFLE
criteria (Pediatric Risk, Injury, Failure, Loss, and End-stage Kidney Disease).
Results. 58 patients (28.6%) developed AKI: 40 had AKI with a severity classified as risk (R),
14 had AKI classified as injury (I) and 4 had AKI classified as injury (F). RACHS-1 (Risk-
Adjusted classification for Congenital Heart Surgery) category, fluid administration as well as
fluid overload were compared between patients with and without AKI. Longer cardiopulmonary
bypass (CPB) time (P=0.03) and vasoactive-inotropic score (P=0.0002) were independent risk
factors for AKI. Fluid overload and intraoperative lactate level was not a significant predictor for
AKI. Higher pRIFLE classification positively correlated with increased postoperative
mechanical ventilation duration, and longer ICU stay (P=0.01).
Conclusions. In this study, we found a higher prevalence of postoperative AKI in pediatric
patients undergoing severe cardiac surgery. AKI was associated with worse early postoperative
outcomes. Early prediction and appropriate treatment of AKI during the postoperative period are
emphasized.
