Association Between Plasma-free Haemoglobin and Postoperative Acute Kidney Injury in Paediatric Cardiac Surgery: a Prospective Observational Study

Overview

Journal BJA Open

Specialty Anesthesiology

Date 2024 Nov 21

PMID 39568616

Authors

Takanobu Sakura

Tomoyuki Kanazawa

Tatsuhiko Shimizu

Kazuyoshi Shimizu

Tatsuo Iwasaki

Hiroshi Morimatsu

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) is a common complication among patients requiring cardiopulmonary bypass (CPB) during paediatric cardiac surgery. Plasma-free haemoglobin (PFH) produced by haemolysis during CPB contributes to AKI. This study aimed to determine the association between PFH and postoperative AKI during paediatric cardiac surgery requiring CPB.

Methods: This prospective, single-centre, observational study included children aged <5 yr who underwent cardiac surgery requiring CPB. PFH was measured pre-CPB, every 30 min during CPB, after modified ultrafiltration, on ICU admission, and once a day at 1-3 days after surgery. The study outcome included the relationship between peak PFH concentrations and the development of postoperative AKI up to 3 days after surgery. Additionally, multivariable analysis was performed to determine the risk factors for AKI.

Results: Of 179 patients, 74 (41%) developed postoperative AKI. Patients who developed AKI had significantly higher peak PFH concentrations (80 mg dl [inter-quartile range, 50-132.5] 60 mg dl [40-100]; =0.006). Multivariable analysis did not identify peak PFH concentrations as an independent risk factor for postoperative AKI (odds ratio [OR] 1.00; 95% confidence interval [CI]: 0.99-1.00; =0.268). Factors associated with postoperative AKI were age in months (OR 0.96; 95% CI: 0.94-0.99; =0.007) and CPB duration (OR 1.02; 95% CI: 1.01-1.02; <0.001).

Conclusions: There was an association between postoperative AKI and CPB time rather than PFH. Perioperative peak PFH concentrations were significantly higher in patients with postoperative AKI after paediatric cardiac surgery requiring CPB.

References

LoBasso M, Schneider J, Sanchez-Pinto L, Del Castillo S, Kim G, Flynn A . Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol. 2021; 37(3):659-665. DOI: 10.1007/s00467-021-05179-5. View

Pedersen K . Acute kidney injury in children undergoing surgery for congenital heart disease. Eur J Pediatr Surg. 2012; 22(6):426-33. DOI: 10.1055/s-0032-1322540. View

Borasino S, Kalra Y, Elam A, Carlisle OMeara L, Timpa J, Goldberg K . Impact of Hemolysis on Acute Kidney Injury and Mortality in Children Supported with Cardiac Extracorporeal Membrane Oxygenation. J Extra Corpor Technol. 2018; 50(4):217-224. PMC: 6296454. View

Oh J, Hamm J, Xu X, Genschmer K, Zhong M, Lebensburger J . Absorbance and redox based approaches for measuring free heme and free hemoglobin in biological matrices. Redox Biol. 2016; 9:167-177. PMC: 5007433. DOI: 10.1016/j.redox.2016.08.003. View

Neumayr T, Alge J, Afonso N, Akcan-Arikan A . Acute Kidney Injury After Pediatric Cardiac Surgery. Pediatr Crit Care Med. 2022; 23(5):e249-e256. DOI: 10.1097/PCC.0000000000002933. View

Aydin S, Seiden H, Blaufox A, Parnell V, Choudhury T, Punnoose A . Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg. 2012; 94(5):1589-95. DOI: 10.1016/j.athoracsur.2012.06.050. View

Billings 4th F, Ball S, Roberts 2nd L, Pretorius M . Postoperative acute kidney injury is associated with hemoglobinemia and an enhanced oxidative stress response. Free Radic Biol Med. 2011; 50(11):1480-7. PMC: 3090463. DOI: 10.1016/j.freeradbiomed.2011.02.011. View

Mamikonian L, Mamo L, Smith P, Koo J, Lodge A, Turi J . Cardiopulmonary bypass is associated with hemolysis and acute kidney injury in neonates, infants, and children*. Pediatr Crit Care Med. 2014; 15(3):e111-9. PMC: 3951557. DOI: 10.1097/PCC.0000000000000047. View

Peduzzi P, Concato J, Kemper E, Holford T, Feinstein A . A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996; 49(12):1373-9. DOI: 10.1016/s0895-4356(96)00236-3. View

10.

Ishikura K, Uemura O, Ito S, Wada N, Hattori M, Ohashi Y . Pre-dialysis chronic kidney disease in children: results of a nationwide survey in Japan. Nephrol Dial Transplant. 2013; 28(9):2345-55. DOI: 10.1093/ndt/gfs611. View

11.

Kim-Campbell N, Gretchen C, Callaway C, Felmet K, Kochanek P, Maul T . Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass. Crit Care Med. 2017; 45(11):e1123-e1130. PMC: 5657595. DOI: 10.1097/CCM.0000000000002703. View

12.

Schwartz G, Furth S . Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol. 2007; 22(11):1839-48. DOI: 10.1007/s00467-006-0358-1. View

13.

Kellum J, Lameire N . Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17(1):204. PMC: 4057151. DOI: 10.1186/cc11454. View

14.

Dalton H, Cashen K, Reeder R, Berg R, Shanley T, Newth C . Hemolysis During Pediatric Extracorporeal Membrane Oxygenation: Associations With Circuitry, Complications, and Mortality. Pediatr Crit Care Med. 2018; 19(11):1067-1076. PMC: 6218309. DOI: 10.1097/PCC.0000000000001709. View

15.

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

16.

Liberio B, Brinton J, Gist K, Soranno D, Kirkley M, Gien J . Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia. J Perinatol. 2021; 41(8):1901-1909. PMC: 8196921. DOI: 10.1038/s41372-021-01119-1. View

17.

ONeal J, Shaw A, Billings 4th F . Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016; 20(1):187. PMC: 4931708. DOI: 10.1186/s13054-016-1352-z. View

18.

Jenkins K, Gauvreau K, Newburger J, Spray T, Moller J, Iezzoni L . Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002; 123(1):110-8. DOI: 10.1067/mtc.2002.119064. View

19.

Graw J, Hildebrandt P, Krannich A, Balzer F, Spies C, Francis R . The role of cell-free hemoglobin and haptoglobin in acute kidney injury in critically ill adults with ARDS and therapy with VV ECMO. Crit Care. 2022; 26(1):50. PMC: 8864920. DOI: 10.1186/s13054-022-03894-5. View

20.

Hu J, Rezoagli E, Zadek F, Bittner E, Lei C, Berra L . Free Hemoglobin Ratio as a Novel Biomarker of Acute Kidney Injury After On-Pump Cardiac Surgery: Secondary Analysis of a Randomized Controlled Trial. Anesth Analg. 2021; 132(6):1548-1558. PMC: 8154645. DOI: 10.1213/ANE.0000000000005381. View