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Kidney Week

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


  • 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


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.


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.


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).


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.


  • NIDDK Support