Evaluation of kidney functions retrospectively in the early period after surgery for congenital heart disease

Acute kidney injury (AKI) after cardiac surgery in neonates with congenital heart disease is a serious complication closely associated with high morbidity and mortality. This study aimed to characterize AKI associated with cardiac surgery in neonates, determine its incidence, perioperative and postoperative risk factors and short-term results. This study included 177 neonates (≤28 days) who were operated on for congenital heart disease in our hospital between January 2015 and December 2019 and followed up in the pediatric cardiovascular surgery intensive care unit. The data of the patients were analyzed retrospectively. nKDIGO (neonatal Kidney Disease Improving Global Outcomes), pRIFLE (pediatric Risk, Injury, Failure, Loss, End-stage kidney disease) and nRIFLE (neonatal Risk, Injury, Failure, Loss, End-stage kidney disease) criteria in the evaluation of acute kidney injury It was used separately in our study. Data of groups with and without AKI were analyzed. In our study, the incidence of cardiac surgery-associated acute kidney injury (CS-AKI) in neonates was; %12,5, %40,8 and %21,5 for nKDIGO, pRIFLE, and nRIFLE. In all three classifications, the duration of cardiopulmonary bypass, operation, inotropic treatment and mechanical ventilation, follow-up time in intensive care unit and hospitalization time were significantly higher in the AKI group than those without AKI (p˂0.05). In our study, in the first 24 hours after surgery peak serum lactate levels and metabolic acidosis, the rate of postoperative arrhythmia, delayed sternal closure and renal replacement therapy were found to be higher in all 3 classifications related to CS-AKI. Considering the effect of AKI on the mortality of the patients, according to the nKDIGO and nRIFLE classifications, the mortality rate in the groups with AKI was found to be significantly higher (p˂0.05) than the groups without AKI. In statistical analysis, when all 3 classifications were compared according to AKI stages after cardiac surgery, a significant agreement was found between nKDIGO and pRIFLE and nRIFLE classifications. Early identification of AKI associated with cardiac surgery is important to reduce postoperative mortality and morbidity. More prospective studies investigating AKI after cardiac surgery with the contribution of developing surgical procedures, anesthesia techniques and postoperative care should cover neonates.