The following is a summary of “Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON,” published in the December 2023 issue of Nephrology by Hasson et al.
Despite the prevalence of Cardiac Surgery-Associated Acute Kidney Injury (CS-AKI), its impact on clinical outcomes varies. Analyzing CS-AKI sub-phenotypes and incorporating positive Cumulative Fluid Balance (CFB) could lead to better prognosis prediction.
Researchers conducted a retrospective study investigating if dividing CS-AKI into sub-phenotypes based on duration and integrating positive CFB improves the association with outcomes in neonates after the Norwood procedure.
They conducted a multicenter study from the Neonatal and Pediatric Heart and Renal Outcomes Network. Transient CS-AKI was considered if present only on postoperative day (POD) 1 and/or 2, while persistent CS-AKI persisted beyond POD 2. Measured daily and peak CFB over the first 7 postoperative days. Primary and secondary outcomes included mortality, respiratory support-free days at 28, and hospital-free days at 60. The main predictor was persistent CS-AKI, defined by modified neonatal KDIGO criteria.
The results showed CS-AKI in 59% (205/347) of neonates: 36.6% (127/347) were transient, and 22.5% (78/347) were persistent; CFB > 10% occurred in 18.7% (65/347). Patients with either persistent CS-AKI or peak CFB > 10% had higher mortality. The combination of persistent CS-AKI with peak CFB > 10% (n = 21) was associated with increased mortality (aOR: 7.8, 95% CI: 1.4, 45.5; P=0.02), decreased respiratory support-free (predicted mean 12 vs. 19; P<0.001), and hospital-free days (17 vs. 29; P=0.048) compared to those with neither.
They concluded that persistent CS-AKI + peak CFB > 10% after Norwood was linked to increased mortality and resource use. Future studies focusing on reducing risk factors and CFB may improve outcomes.
Source: link.springer.com/article/10.1007/s00467-023-06235-y