Acute kidney injury and risk factors after coarctation of the aorta repair without cardiopulmonary bypass in children first year of life: one-single center, propensity score matching analysis

Background: Cardiac surgery-associated acute kidney injury (CSA- AKI) in children with congenital heart defects (CHD) remains one of the key challenges in pediatric cardiac surgery. Most studies examining this complication focus on patients undergoing cardiopulmonary bypass for CHD correction. Cardiopulmonary bypass and its duration are the most significant factors in the development of CSA-AKI. Objective: The study aimed to assess the incidence of CSA-AKI using pRIFLE and KDIGO criteria in patients after coarctation repair without cardiopulmonary bypass, as well as to identify possible predictors of CSA-AKI and determine risk factors after surgery. Methods: One-single center, retrospective, propensity score matching analysis included 80 patients aged up to 1 year with coarctation of the aorta after cardiac surgery without cardiopulmonary bypass. Results: The incidence of acute kidney injury according to the pRIFLE and KDIGO criteria was 48.8 % and 35 %, respectively. Matched group of patients with CSA-AKI had longer duration of mechanical ventilation and day stay in intensive care unit after surgery (р < 0.001). With increasing patient age, the length of stay in the intensive care unit and the duration of mechanical ventilation went up. With an increase of RACHS-1 score from 1 to 2 and 3, the duration of stay in the intensive care unit augmented by 8.2 and 11 days, respectively (p = 0.004). Patients with prostaglandin infusions before surgery had a 1.6 ml/kg/hour more urine output in the first postoperative day. Conclusion: Despite significant progress in the investigation of acute kidney injury in pediatric patients after cardiac surgery, many unresolved issues remain requiring further study to fully unravel the complexities of AKI diagnosis and treatment in the pediatric population undergoing cardiac surgery.