Acute kidney injury in congenital cardiac surgery: Pediatric risk–injury–failure–loss–end‐stage renal disease and Acute Kidney Injury Network

Background Acute kidney injury (AKI) is associated with an increased risk of mortality especially in pediatric intensive care units. The aim of this study is to determine the risk factors of AKI in children undergoing cardiac surgery for congenital heart disease and compare two different classification systems: pRIFLE and AKIN. Methods We retrospectively analyzed 145 patient undergoing pediatric congenital heart surgery who were between 1 month and 18 years and treated by the cardiovascular surgery department from January 2009 to October 2011. Results One hundred and thirty-seven patients (mean age 36.6 ± 43.3 months) were enrolled: 84 (61.3%) patients developed AKI by pRIFLE criteria (25.5% Risk, 20.4% “Injury”, 15.3% “Failure”); 65 (47.4%) of patients developed AKI according to the AKIN criteria (15.3% stage I, 18.2% stage II, and 13.9% stage III). Children younger than 11 months were more likely to develop AKI (p<0.005). Longer cardiopulmonary bypass time was associated with an increased risk of AKI (p<0.05). pRIFLE identified AKI more frequently than AKIN (p<0.0005). pRIFLE may help in the early identification of patient at risk for AKI and seems to more sensitive in pediatric patients (p <0.05). Any degree of AKI in both classifications were associated with increased mortality [OR:15.1 pRIFLE; OR: 11.2 AKIN p(0.007)]. Conclusion pRIFLE identified AKI more frequently than AKIN criteria. pRIFLE identify patients at risk for AKI early and is more sensitive in pediatric patients. Any degree of AKI in both classifications was associated with increased of mortality. Mortality was the same in both criteria. This article is protected by copyright. All rights reserved.