• Dominic Zanaboni, Jungwon Min, Roopa Seshadri, J William Gaynor, Molly Dreher, and Joshua J Blinder.
• Division of Pediatric Cardiology, University of Michigan C.S. Mott Children's Hospital, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA. zanaboni@med.umich.edu.
• Pediatr. Nephrol. 2021 Sep 1; 36 (9): 2875-2881.

BackgroundUltrafiltration (UF) is used for fluid removal during and after infant cardiopulmonary bypass (CPB) surgery to reduce fluid overload. Excessive UF may have the opposite of its intended effect, resulting in acute kidney injury (AKI), oliganuria, and fluid retention.MethodsThis is a single-center, retrospective review of infants treated with conventional and/or modified UF during CPB surgery. UF volume was indexed to weight. AKI was defined using serum creatinine "Kidney Disease Improving Global Outcome (KDIGO)" criteria. Fluid balance was defined according to: [Formula: see text]. Peak fluid overload was determined on postoperative day 3. Multivariable logistic regression adjusted for multiple covariates was used to explore associations with UF, AKI, and fluid overload.ResultsFive hundred thirty subjects < 1 year of age underwent CPB-assisted congenital heart surgery with UF. Sixty-four (12%) developed postoperative AKI. On multivariable regression, higher indexed total UF volume was associated with increased AKI risk (OR 1.11, 95% CI=1.04-1.19, p = 0.003). UF volume > 119.9 mL/kg did not reduce peak fluid overload. Subjects with AKI took longer to reach a negative fluid balance (2 vs. 3 days, p = 0.04). Those with more complex surgery were at highest AKI risk (STAT 3 [25-75 percentile: 3-4] in AKI group versus STAT 3 [25-75 percentile: 2-4] in non-AKI group, p = 0.05). AKI was reduced in subjects undergoing more complex surgery and treated with UF volume < 119.9 mL/kg.ConclusionsJudicious use of UF in more complex congenital cardiac surgery reduces the risk of AKI.© 2021. IPNA.

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