• Denise C Hasson, John T Brinton, Ellen Cowherd, Danielle E Soranno, and Katja M Gist.
• Department of Graduate Medical Education, University of Colorado Anschutz Medical Campus, Aurora, CO.
• Pediatr Crit Care Me. 2019 Jul 1; 20 (7): 614-620.

ObjectivesDetermine the risk factors for repeated episodes of acute kidney injury in children who undergo multiple cardiac surgical procedures.DesignSingle-center retrospective chart review.SettingCardiac ICU at a quaternary pediatric care center.PatientsBirth to 18 years who underwent at least two cardiac surgical procedures with cardiopulmonary bypass.InterventionsNone.Measurements And Main ResultsOne-hundred eighty patients underwent two cardiac surgical procedures and 89 underwent three. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes serum creatinine criteria. Acute kidney injury frequency was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most acute kidney injury occurring on postoperative days 1 and 2. The proportion of patients with severe acute kidney injury increased from surgery 1 to surgery 3. Patients with acute kidney injury had a significantly longer duration of ventilation and length of stay after each surgery. The odds of acute kidney injury after surgery 3 was 2.40 times greater if acute kidney injury was present after surgery 1 or 2 (95% CI, 1.26-4.56; p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with acute kidney injury (p = 0.85).ConclusionsIn a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of acute kidney injury after a third surgery was increased by the presence of acute kidney injury after prior procedures. Time between surgery did not play a role in increasing odds of acute kidney injury. Further studies in a larger multicenter investigation are necessary to confirm these findings.

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