Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure
Background: Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for po...
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| Veröffentlicht in: | World journal for pediatric & congenital heart surgery 2017-05, Vol.8 (3), p.367-375 |
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| container_title | World journal for pediatric & congenital heart surgery |
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| creator | Patterson, Taylor Hehir, David A. Buelow, Matthew Simpson, Pippa M. Mitchell, Michael E. Zhang, Liyun Eslami, Mehdi Murkowski, Kathleen Scott, John P. |
| description | Background:
Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for post-Fontan AKI.
Methods:
Single-center retrospective study of children undergoing Fontan completion from 2005 to 2012. Demographic and hemodynamic variables were assessed for association with AKI. Subgroup analysis was performed on patients with high-grade AKI (creatinine increase of ≥2.0 × baseline). Vital sign data were collected hourly for the first postoperative day.
Results:
A total of 186 patients underwent Fontan at 3.1 (2.5-3.8) years of age and 13.5 kg (12.2-15.1). Acute kidney injury occurred in 97 (52%) patients, with high-grade AKI in 52 (28%). Univariate analysis identified reduced RPP in patients with AKI compared to those without AKI, 50 (45-56) mm Hg versus 58 (54-61) mm Hg (P < .0001), due to lower mean arterial blood pressure, 63 (60-69) versus 70 (66-73) mm Hg (P < .0001), and higher central venous pressure, 14 (12-16) versus 13 (11-14) mm Hg, (p < .0001). Multivariable logistic regression and classification tree analyses further identified elements of RPP as significant predictors of AKI, especially high-grade AKI. Postoperative intubation was linked to AKI development. Patients with AKI had decreased postoperative urine output with increased colloid requirements, duration of chest tube insertion, and hospital length of stay.
Conclusion:
Acute kidney injury occurs frequently following the Fontan procedure. Associated factors include reduced RPP, high colloid requirements, and postoperative intubation. Targeted hemodynamic interventions may serve to reduce the incidence of post-Fontan AKI. |
| doi_str_mv | 10.1177/2150135117701376 |
| format | Article |
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Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for post-Fontan AKI.
Methods:
Single-center retrospective study of children undergoing Fontan completion from 2005 to 2012. Demographic and hemodynamic variables were assessed for association with AKI. Subgroup analysis was performed on patients with high-grade AKI (creatinine increase of ≥2.0 × baseline). Vital sign data were collected hourly for the first postoperative day.
Results:
A total of 186 patients underwent Fontan at 3.1 (2.5-3.8) years of age and 13.5 kg (12.2-15.1). Acute kidney injury occurred in 97 (52%) patients, with high-grade AKI in 52 (28%). Univariate analysis identified reduced RPP in patients with AKI compared to those without AKI, 50 (45-56) mm Hg versus 58 (54-61) mm Hg (P < .0001), due to lower mean arterial blood pressure, 63 (60-69) versus 70 (66-73) mm Hg (P < .0001), and higher central venous pressure, 14 (12-16) versus 13 (11-14) mm Hg, (p < .0001). Multivariable logistic regression and classification tree analyses further identified elements of RPP as significant predictors of AKI, especially high-grade AKI. Postoperative intubation was linked to AKI development. Patients with AKI had decreased postoperative urine output with increased colloid requirements, duration of chest tube insertion, and hospital length of stay.
Conclusion:
Acute kidney injury occurs frequently following the Fontan procedure. Associated factors include reduced RPP, high colloid requirements, and postoperative intubation. Targeted hemodynamic interventions may serve to reduce the incidence of post-Fontan AKI.</description><identifier>ISSN: 2150-1351</identifier><identifier>EISSN: 2150-136X</identifier><identifier>DOI: 10.1177/2150135117701376</identifier><identifier>PMID: 28520545</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Acute Kidney Injury - epidemiology ; Acute Kidney Injury - physiopathology ; Child, Preschool ; Female ; Fontan Procedure - adverse effects ; Heart Defects, Congenital - mortality ; Heart Defects, Congenital - surgery ; Hemodynamics - physiology ; Humans ; Incidence ; Kidney - physiopathology ; Male ; Postoperative Complications - epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate - trends ; United States - epidemiology</subject><ispartof>World journal for pediatric & congenital heart surgery, 2017-05, Vol.8 (3), p.367-375</ispartof><rights>The Author(s) 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c473t-1527e8dbb8cb09baee0e86cb680bb7b85304d3fa41705e45d180d39bf36c0aac3</citedby><cites>FETCH-LOGICAL-c473t-1527e8dbb8cb09baee0e86cb680bb7b85304d3fa41705e45d180d39bf36c0aac3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/2150135117701376$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/2150135117701376$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28520545$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Patterson, Taylor</creatorcontrib><creatorcontrib>Hehir, David A.</creatorcontrib><creatorcontrib>Buelow, Matthew</creatorcontrib><creatorcontrib>Simpson, Pippa M.</creatorcontrib><creatorcontrib>Mitchell, Michael E.</creatorcontrib><creatorcontrib>Zhang, Liyun</creatorcontrib><creatorcontrib>Eslami, Mehdi</creatorcontrib><creatorcontrib>Murkowski, Kathleen</creatorcontrib><creatorcontrib>Scott, John P.</creatorcontrib><title>Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure</title><title>World journal for pediatric & congenital heart surgery</title><addtitle>World J Pediatr Congenit Heart Surg</addtitle><description>Background:
Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for post-Fontan AKI.
Methods:
Single-center retrospective study of children undergoing Fontan completion from 2005 to 2012. Demographic and hemodynamic variables were assessed for association with AKI. Subgroup analysis was performed on patients with high-grade AKI (creatinine increase of ≥2.0 × baseline). Vital sign data were collected hourly for the first postoperative day.
Results:
A total of 186 patients underwent Fontan at 3.1 (2.5-3.8) years of age and 13.5 kg (12.2-15.1). Acute kidney injury occurred in 97 (52%) patients, with high-grade AKI in 52 (28%). Univariate analysis identified reduced RPP in patients with AKI compared to those without AKI, 50 (45-56) mm Hg versus 58 (54-61) mm Hg (P < .0001), due to lower mean arterial blood pressure, 63 (60-69) versus 70 (66-73) mm Hg (P < .0001), and higher central venous pressure, 14 (12-16) versus 13 (11-14) mm Hg, (p < .0001). Multivariable logistic regression and classification tree analyses further identified elements of RPP as significant predictors of AKI, especially high-grade AKI. Postoperative intubation was linked to AKI development. Patients with AKI had decreased postoperative urine output with increased colloid requirements, duration of chest tube insertion, and hospital length of stay.
Conclusion:
Acute kidney injury occurs frequently following the Fontan procedure. Associated factors include reduced RPP, high colloid requirements, and postoperative intubation. Targeted hemodynamic interventions may serve to reduce the incidence of post-Fontan AKI.</description><subject>Acute Kidney Injury - epidemiology</subject><subject>Acute Kidney Injury - physiopathology</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Fontan Procedure - adverse effects</subject><subject>Heart Defects, Congenital - mortality</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kidney - physiopathology</subject><subject>Male</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Rate - trends</subject><subject>United States - epidemiology</subject><issn>2150-1351</issn><issn>2150-136X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kMFLwzAUxoMobszdPUmOXqrJkrSZtzGcGw4couCtJOnr7GiTmbRI_3tbNncQfJfvvcfv-w4fQteU3FGaJPcTKghlot87TeIzNOxfEWXxx_lpF3SAxiHsSDc8ZozzSzSYSDEhgoshqpZQuay1qioM3niXFyVgl-OZaWrAz0VmocUru2t8ixeuLN13Ybe4_oTusrWyvcdA1nh4wKtqr0zdu1_BqhJvwOdNKFwPQQgdc4UuclUGGB91hN4Xj2_zZbR-eVrNZ-vI8ITVERWTBGSmtTSaTLUCICBjo2NJtE60FIzwjOWK04QI4CKjkmRsqnMWG6KUYSN0e8jde_fVQKjTqggGylJZcE1I6ZQQySQTokPJATXeheAhT_e-qJRvU0rSvtv0b8-d5eaY3ugKspPht9UOiA5AUFtId67xXR3h_8AfI6OFYA</recordid><startdate>201705</startdate><enddate>201705</enddate><creator>Patterson, Taylor</creator><creator>Hehir, David A.</creator><creator>Buelow, Matthew</creator><creator>Simpson, Pippa M.</creator><creator>Mitchell, Michael E.</creator><creator>Zhang, Liyun</creator><creator>Eslami, Mehdi</creator><creator>Murkowski, Kathleen</creator><creator>Scott, John P.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201705</creationdate><title>Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure</title><author>Patterson, Taylor ; Hehir, David A. ; Buelow, Matthew ; Simpson, Pippa M. ; Mitchell, Michael E. ; Zhang, Liyun ; Eslami, Mehdi ; Murkowski, Kathleen ; Scott, John P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c473t-1527e8dbb8cb09baee0e86cb680bb7b85304d3fa41705e45d180d39bf36c0aac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acute Kidney Injury - epidemiology</topic><topic>Acute Kidney Injury - physiopathology</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Fontan Procedure - adverse effects</topic><topic>Heart Defects, Congenital - mortality</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Kidney - physiopathology</topic><topic>Male</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Rate - trends</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Patterson, Taylor</creatorcontrib><creatorcontrib>Hehir, David A.</creatorcontrib><creatorcontrib>Buelow, Matthew</creatorcontrib><creatorcontrib>Simpson, Pippa M.</creatorcontrib><creatorcontrib>Mitchell, Michael E.</creatorcontrib><creatorcontrib>Zhang, Liyun</creatorcontrib><creatorcontrib>Eslami, Mehdi</creatorcontrib><creatorcontrib>Murkowski, Kathleen</creatorcontrib><creatorcontrib>Scott, John P.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>World journal for pediatric & congenital heart surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Patterson, Taylor</au><au>Hehir, David A.</au><au>Buelow, Matthew</au><au>Simpson, Pippa M.</au><au>Mitchell, Michael E.</au><au>Zhang, Liyun</au><au>Eslami, Mehdi</au><au>Murkowski, Kathleen</au><au>Scott, John P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure</atitle><jtitle>World journal for pediatric & congenital heart surgery</jtitle><addtitle>World J Pediatr Congenit Heart Surg</addtitle><date>2017-05</date><risdate>2017</risdate><volume>8</volume><issue>3</issue><spage>367</spage><epage>375</epage><pages>367-375</pages><issn>2150-1351</issn><eissn>2150-136X</eissn><abstract>Background:
Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for post-Fontan AKI.
Methods:
Single-center retrospective study of children undergoing Fontan completion from 2005 to 2012. Demographic and hemodynamic variables were assessed for association with AKI. Subgroup analysis was performed on patients with high-grade AKI (creatinine increase of ≥2.0 × baseline). Vital sign data were collected hourly for the first postoperative day.
Results:
A total of 186 patients underwent Fontan at 3.1 (2.5-3.8) years of age and 13.5 kg (12.2-15.1). Acute kidney injury occurred in 97 (52%) patients, with high-grade AKI in 52 (28%). Univariate analysis identified reduced RPP in patients with AKI compared to those without AKI, 50 (45-56) mm Hg versus 58 (54-61) mm Hg (P < .0001), due to lower mean arterial blood pressure, 63 (60-69) versus 70 (66-73) mm Hg (P < .0001), and higher central venous pressure, 14 (12-16) versus 13 (11-14) mm Hg, (p < .0001). Multivariable logistic regression and classification tree analyses further identified elements of RPP as significant predictors of AKI, especially high-grade AKI. Postoperative intubation was linked to AKI development. Patients with AKI had decreased postoperative urine output with increased colloid requirements, duration of chest tube insertion, and hospital length of stay.
Conclusion:
Acute kidney injury occurs frequently following the Fontan procedure. Associated factors include reduced RPP, high colloid requirements, and postoperative intubation. Targeted hemodynamic interventions may serve to reduce the incidence of post-Fontan AKI.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>28520545</pmid><doi>10.1177/2150135117701376</doi><tpages>9</tpages></addata></record> |
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| ispartof | World journal for pediatric & congenital heart surgery, 2017-05, Vol.8 (3), p.367-375 |
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| source | MEDLINE; SAGE Complete |
| subjects | Acute Kidney Injury - epidemiology Acute Kidney Injury - physiopathology Child, Preschool Female Fontan Procedure - adverse effects Heart Defects, Congenital - mortality Heart Defects, Congenital - surgery Hemodynamics - physiology Humans Incidence Kidney - physiopathology Male Postoperative Complications - epidemiology Retrospective Studies Risk Factors Survival Rate - trends United States - epidemiology |
| title | Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure |
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