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Abstract: FR-PO021

The Association of AKI with Hospital Readmission or Death After Pediatric Cardiac Surgery

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Nunes, Sophia, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Greenberg, Jason Henry, Yale University, Woodbridge, Connecticut, United States
  • Parikh, Chirag R., Johns Hopkins University, Newton, Massachusetts, United States
  • Brown, Jeremiah R., The Dartmouth Institute, Lebanon, New Hampshire, United States
  • Thiessen Philbrook, Heather, Johns Hopkins University, Newton, Massachusetts, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Palijan, Ana, McGill University Health Centre, Montreal, Quebec, Canada
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Group or Team Name

  • TRIBE-AKI
Background

AKI in children undergoing cardiac surgery (CS) is strongly associated with increased hospital morbidity, however post-discharge AKI outcomes are less studied. Hypotheses: In children undergoing CS with cardiopulmonary bypass (CPB), a) AKI is associated with increased risk for readmission or death within 30 days and 1 year of CS discharge, and b) the association of AKI with outcomes is modified by surgical severity and cyanotic heart disease.

Methods

Prospective 3-centre cohort study of children surviving to hospital discharge after CS with CPB. Main exposure: AKI during index CS admission defined by KDIGO. Composite outcome: readmission to hospital or death at a) 30 days and b) 1 year from CS hospital discharge. Other data: detailed pre/post-op CS patient/treatment variables (including Risk Adjustment for Congenital Heart Surgery-1 [RACHS-1] score; presence of cyanotic heart disease). Association of AKI with time to outcomes was determined using multivariable Cox-proportional hazards analysis (adjusted for age, RACHS-1 score ≥3, CPB time>120 mins). RACHS-1 score≥3 and cyanotic heart disease were evaluated as effect modifiers.

Results

Of the 360 participants included (mean age 4.0±4.6 years, 155 [43%] AKI, 47 [13%] ≥Stage 2 AKI), 4 (1.1%) and 6 (1.7%) died and 30 (8.3%) and 99 (27.5%) were readmitted within 30 days and 1 year post-discharge, respectively. Figure illustrates a graded increase in the risk of the composite outcome with increasing AKI stage. AKI and ≥Stage 2 AKI were associated with time to outcome within 30 days (adjusted HR 2.14 [95%CI 1.04-4.41] and 2.39 [95% CI 1.08-5.27], respectively) but not within 1 year of CS discharge. RACHS-1 and cyanotic heart disease did not modify these relationships (interaction p value>0.1).

Conclusion

Children with AKI post-CS were more likely to be readmitted or die within 30 days of CS discharge, compared to children without AKI. Future research should evaluate measures to reduce short-term morbidity and mortality risk in children who develop AKI after CS.

Funding

  • NIDDK Support