Risk Factors and Outcomes of Acute Kidney Injury in Children With Congenital Heart Disease Following Cardiac Surgery

Objectives: To investigate the incidence and risk factors for Acute kidney injury (AKI) following cardiac surgery in children with congenital heart diseases, and to identify modifiable factors that remain insufficiently studied. Acute kidney injury is common after cardiac surgery for children with congenital heart disease (CHD). Children with AKI are known to have complicated hospital courses, including their need for kidney replacement therapy, and have increased mortality. Methods: We conducted a retrospective analysis of children admitted to the pediatric cardiac intensive care unit (PCICU) at King Abdulaziz University Hospital over 7 years (2014–2021), using the Kidney Disease Improving Global Outcome (KDIGO) definitions and stages of AKI. Results: The cohort included a total of 628 children who had cardiac surgery for congenital heart disease, of whom 186 (29.6%) developed AKI. Children with AKI had significant difference than children without AKI in the following factors: (preoperative characteristics) age younger than one year, advanced score in risk adjustment for congenital heart surgery scores (RACHS-1 score), existing renal anomalies, hypoalbuminemia, and needed cardiac catheterization, (intraoperative factors) longer median cardiopulmonary bypass and aorta cross-clamping durations, had cardiac arrest and required ECMO and respiratory support. The most predictive variables for AKI development in these children were RACHS-1 score, cardiopulmonary bypass duration, cardiac catheter insertion, and presence of renal anomalies. Conclusions: This study provides valuable insights into the risk factors for AKI development in children with CHD following their cardiac surgery. These factors should be addressed in this patient population to reduce the risk of AKI and its following complications.