Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure : report from NEPHRON
© 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association..
BACKGROUND: Cardiac surgery-associated acute kidney injury (CS-AKI) is common, but its impact on clinical outcomes is variable. Parsing AKI into sub-phenotype(s) and integrating pathologic positive cumulative fluid balance (CFB) may better inform prognosis. We sought to determine whether durational sub-phenotyping of CS-AKI with CFB strengthens association with outcomes among neonates undergoing the Norwood procedure.
METHODS: Multicenter, retrospective cohort study from the Neonatal and Pediatric Heart and Renal Outcomes Network. Transient CS-AKI: present only on post-operative day (POD) 1 and/or 2; persistent CS-AKI: continued after POD 2. CFB was evaluated per day and peak CFB during the first 7 postoperative days. Primary and secondary outcomes were mortality, respiratory support-free and hospital-free days (at 28, 60 days, respectively). The primary predictor was persistent CS-AKI, defined by modified neonatal Kidney Disease: Improving Global Outcomes criteria.
RESULTS: CS-AKI occurred in 59% (205/347) neonates: 36.6% (127/347) transient and 22.5% (78/347) persistent; CFB > 10% occurred in 18.7% (65/347). Patients with either persistent CS-AKI or peak CFB > 10% had higher mortality. Combined persistent CS-AKI with peak CFB > 10% (n = 21) associated with increased mortality (aOR: 7.8, 95% CI: 1.4, 45.5; p = 0.02), decreased respiratory support-free (predicted mean 12 vs. 19; p < 0.001) and hospital-free days (17 vs. 29; p = 0.048) compared to those with neither.
CONCLUSIONS: The combination of persistent CS-AKI and peak CFB > 10% after the Norwood procedure is associated with mortality and hospital resource utilization. Prospective studies targeting intra- and postoperative CS-AKI risk factors and reducing CFB have the potential to improve outcomes.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:39 |
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| Enthalten in: |
Pediatric nephrology (Berlin, Germany) - 39(2024), 5 vom: 15. März, Seite 1627-1637 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Hasson, Denise C [VerfasserIn] |
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| Links: |
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| Themen: |
Acute kidney injury |
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| Anmerkungen: |
Date Completed 18.03.2024 Date Revised 26.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00467-023-06235-y |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM365483389 |
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| 100 | 1 | |a Hasson, Denise C |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure |b report from NEPHRON |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Completed 18.03.2024 | ||
| 500 | |a Date Revised 26.03.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s), under exclusive licence to International Pediatric Nephrology Association. | ||
| 520 | |a BACKGROUND: Cardiac surgery-associated acute kidney injury (CS-AKI) is common, but its impact on clinical outcomes is variable. Parsing AKI into sub-phenotype(s) and integrating pathologic positive cumulative fluid balance (CFB) may better inform prognosis. We sought to determine whether durational sub-phenotyping of CS-AKI with CFB strengthens association with outcomes among neonates undergoing the Norwood procedure | ||
| 520 | |a METHODS: Multicenter, retrospective cohort study from the Neonatal and Pediatric Heart and Renal Outcomes Network. Transient CS-AKI: present only on post-operative day (POD) 1 and/or 2; persistent CS-AKI: continued after POD 2. CFB was evaluated per day and peak CFB during the first 7 postoperative days. Primary and secondary outcomes were mortality, respiratory support-free and hospital-free days (at 28, 60 days, respectively). The primary predictor was persistent CS-AKI, defined by modified neonatal Kidney Disease: Improving Global Outcomes criteria | ||
| 520 | |a RESULTS: CS-AKI occurred in 59% (205/347) neonates: 36.6% (127/347) transient and 22.5% (78/347) persistent; CFB > 10% occurred in 18.7% (65/347). Patients with either persistent CS-AKI or peak CFB > 10% had higher mortality. Combined persistent CS-AKI with peak CFB > 10% (n = 21) associated with increased mortality (aOR: 7.8, 95% CI: 1.4, 45.5; p = 0.02), decreased respiratory support-free (predicted mean 12 vs. 19; p < 0.001) and hospital-free days (17 vs. 29; p = 0.048) compared to those with neither | ||
| 520 | |a CONCLUSIONS: The combination of persistent CS-AKI and peak CFB > 10% after the Norwood procedure is associated with mortality and hospital resource utilization. Prospective studies targeting intra- and postoperative CS-AKI risk factors and reducing CFB have the potential to improve outcomes | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute kidney injury | |
| 650 | 4 | |a Database | |
| 650 | 4 | |a Fluid | |
| 650 | 4 | |a Neonatal | |
| 650 | 4 | |a Norwood operation | |
| 650 | 4 | |a Sub-phenotypes | |
| 700 | 1 | |a Alten, Jeffrey A |e verfasserin |4 aut | |
| 700 | 1 | |a Bertrandt, Rebecca A |e verfasserin |4 aut | |
| 700 | 1 | |a Zang, Huaiyu |e verfasserin |4 aut | |
| 700 | 1 | |a Selewski, David T |e verfasserin |4 aut | |
| 700 | 1 | |a Reichle, Garrett |e verfasserin |4 aut | |
| 700 | 1 | |a Bailly, David K |e verfasserin |4 aut | |
| 700 | 1 | |a Krawczeski, Catherine D |e verfasserin |4 aut | |
| 700 | 1 | |a Winlaw, David S |e verfasserin |4 aut | |
| 700 | 1 | |a Goldstein, Stuart L |e verfasserin |4 aut | |
| 700 | 1 | |a Gist, Katja M |e verfasserin |4 aut | |
| 700 | 0 | |a Neonatal, Pediatric Heart, Renal Outcomes Network (NEPHRON) Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Andrew |e investigator |4 oth | |
| 700 | 1 | |a Brandewie, Katie L |e investigator |4 oth | |
| 700 | 1 | |a Bhat, Priya N |e investigator |4 oth | |
| 700 | 1 | |a Diddle, John W |e investigator |4 oth | |
| 700 | 1 | |a Ghbeis, Muhammed |e investigator |4 oth | |
| 700 | 1 | |a Mah, Kenneth E |e investigator |4 oth | |
| 700 | 1 | |a Neumayr, Tara M |e investigator |4 oth | |
| 700 | 1 | |a Raymond, Tia T |e investigator |4 oth | |
| 700 | 1 | |a Prodhan, Parthak |e investigator |4 oth | |
| 700 | 1 | |a Garcia, Xiomara |e investigator |4 oth | |
| 700 | 1 | |a Ramer, Shannon |e investigator |4 oth | |
| 700 | 1 | |a Albertson, Mindy |e investigator |4 oth | |
| 700 | 1 | |a Cooper, David S |e investigator |4 oth | |
| 700 | 1 | |a Rodriguez, Zahidee |e investigator |4 oth | |
| 700 | 1 | |a Lukacs, Mary |e investigator |4 oth | |
| 700 | 1 | |a Gaies, Michael |e investigator |4 oth | |
| 700 | 1 | |a Sammons, Amanda |e investigator |4 oth | |
| 700 | 1 | |a de Toledo, Joan Sanchez |e investigator |4 oth | |
| 700 | 1 | |a Domnina, Yuliya A |e investigator |4 oth | |
| 700 | 1 | |a Saenz, Lucas |e investigator |4 oth | |
| 700 | 1 | |a Baust, Tracy |e investigator |4 oth | |
| 700 | 1 | |a Kluck, Jane |e investigator |4 oth | |
| 700 | 1 | |a Koch, Joshua D |e investigator |4 oth | |
| 700 | 1 | |a Sasaki, Jun |e investigator |4 oth | |
| 700 | 1 | |a Raees, Aanish |e investigator |4 oth | |
| 700 | 1 | |a Afonso, Natasha S |e investigator |4 oth | |
| 700 | 1 | |a O'Neill, Erika R |e investigator |4 oth | |
| 700 | 1 | |a Lasa, Javier J |e investigator |4 oth | |
| 700 | 1 | |a Phillips, Patrick A |e investigator |4 oth | |
| 700 | 1 | |a Hock, Kristal M |e investigator |4 oth | |
| 700 | 1 | |a Borasino, Santiago |e investigator |4 oth | |
| 700 | 1 | |a Kwiatkowski, David |e investigator |4 oth | |
| 700 | 1 | |a Blinder, Joshua |e investigator |4 oth | |
| 700 | 1 | |a Valentine, Kevin |e investigator |4 oth | |
| 700 | 1 | |a Tadphale, Sachin |e investigator |4 oth | |
| 700 | 1 | |a Buckley, Jason R |e investigator |4 oth | |
| 700 | 1 | |a Clarke, Shanelle |e investigator |4 oth | |
| 700 | 1 | |a Zhang, Wenying |e investigator |4 oth | |
| 700 | 1 | |a Absi, Mohammed |e investigator |4 oth | |
| 700 | 1 | |a Askenazi, David J |e investigator |4 oth | |
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