Acute kidney injury following cardiac surgery in children -application of pRIFLE-

  • Yuichiro Toda, Department of Anesthesia, Okayama University Medical School, Japan
  • Tatsuo Iwasaki, Department of Anesthesia, Okayama University Medical School, Japan
  • Kazuyoshi Shimizu, Department of Anesthesia, Okayama University Medical School, Japan
  • Satoshi Suzuki, Department of Anesthesia, Okayama University Medical School, Japan
  • Tomohiko Suemori, Department of Anesthesia, Okayama University Medical School, Japan
  • Prof Kiyoshi Morita, Department of Anesthesia, Okayama University Medical School, Japan
  • Shingo Kasahara, Department of Cardiac Surgery, Okayama University Medical School, Japan
  • Prof Shunji Sano, Department of Cardiac Surgery, Okayama University Medical School, Japan

    • Objective: To identify incidence of Acute kidney injury(AKI) and outcome of this complication in children following cardiac surgery.
    Methods: A retrospective cohort study using the prospectively collected electronic database. Children under 18 years old admitted to cardiac care unit (CCU) during 2007 were included. Only creatinin component of pRIFLE criteria(Akcan-Arikan, Kidney Int 71, 2007) was used to classify AKI in this study. Then patients were categorized into Normal (N), Risk (R), Injury (I), or Failure (F) by change in Estimated creatinin clearance.
    Results:Our data identified 322 children under 18 years of age. Their median age was 20.5 months, body weight was 8.6 kg and gender male was 183/322(56.8%). By the pRIFLE criteria, there were 100 children with AKI on admission to CCU. Forty-four children were classified as R, 26 were I, and 33 were F. Some of them developed to worse category judged by max serum creatinin during stay. These children with AKI had significantly higher mortality (7.0% vs 0.45%, p=0.0014), longer duration of mechanical ventilation (75 vs 8 hrs, p<0.0001), longer duration of CCU stay (7 vs 4 days, p<0.0001), and higher incidence of peritoneal dialysis requirement (16.0 vs 2.3%) compared with children without AKI.
    Conclusion: About one third of children under 18 years of age following cardiac surgery developed AKI within 24 hrs after admission to intensive care unit when classified by the creatinin component of pRIFLE. These children with AKI required more ventilatory and/or renal supports.