The association of acute kidney injury with hospital readmission and death after pediatric cardiac surgeryCentral MessagePerspective
Sophia Nunes, MSc,
Jeremiah Brown, PhD, MS,
Chirag R. Parikh, MD, PhD,
Jason H. Greenberg, MD, MHS,
Prasad Devarajan, MD,
Heather Theissen Philbrook, PhD, MMath,
Michael Pizzi, BSc,
Ana Palijan, PhD, MS,
Michael Zappitelli, MD, MSc
Affiliations
Sophia Nunes, MSc
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
Jeremiah Brown, PhD, MS
Departments of Epidemiology and Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH
Chirag R. Parikh, MD, PhD
Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
Jason H. Greenberg, MD, MHS
Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
Prasad Devarajan, MD
Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Heather Theissen Philbrook, PhD, MMath
Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md
Michael Pizzi, BSc
McGill University Health Research Institute Centre, Montreal, Québec, Canada
Ana Palijan, PhD, MS
McGill University Health Research Institute Centre, Montreal, Québec, Canada
Michael Zappitelli, MD, MSc
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada; Address for reprints: Michael Zappitelli, MD, MSc, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay St, 11th Floor, Room 11.9722, Toronto, Ontario, M5G 0A4 Canada.
Background: Acute kidney injury (AKI) in children undergoing cardiac surgery (CS) is strongly associated with increased hospital mortality and length of stay. The association of AKI with postdischarge outcomes is unclear. We evaluated the association of AKI with all-cause readmissions and death within 30 days and 1 year of CS discharge. Methods: This was a prospective, 3-center cohort study of children after CS with cardiopulmonary bypass. The primary exposures were postoperative ≥stage 1 AKI and ≥stage 2 AKI defined by Kidney Disease: Improving Global Outcomes AKI definition. Two separate outcomes were hospital readmission and death within 30 days and 1 year of discharge. Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis. Age, The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery risk adjustment tool score ≥3, cardiopulmonary bypass >120 minutes, and cyanotic heart disease were evaluated as effect modifiers. Results: Of 402 participants included (median age 1.8 years [interquartile range 0.4, 5.2]), 32 (8.0%) and 109 (27.1%) were readmitted; 7 (1.7%) and 9 (2.2%) died within 30 days and 1 year of CS, respectively. AKI was not associated with readmission at 30 days or 1 year postdischarge. ≥Stage 2 AKI (adjusted hazard ratio, 11.68 [1.88, 72.61]) was associated with mortality 30 days post-CS. Conclusions: Postoperative AKI was not associated with readmission at 30 days and 1-year postdischarge. However, more severe AKI (≥stage 2) appears to be associated with increased morality risk at 30 days post-CS.
