Acute Kidney Injury Following Congenital Heart Surgery and Its Associated Risk Factors

Objectives: This study aimed to determine the incidence of acute kidney injury (AKI) and identify risk factors associated with its development in pediatric patients undergoing congenital heart surgery with cardiopulmonary bypass (CPB).
Methods: A prospective study was conducted between May 1, 2022, and May 1, 2023, in a pediatric cardiac intensive care unit. Children under 16 years of age who underwent congenital heart surgery with CPB were included. Postoperative AKI was classified using the pRIFLE criteria. Various clinical and perioperative factors were analyzed for their association with AKI.
Results: A total of 640 patients were included, with a median age of 12 months (IQR 6–24); 52% were male. AKI occurred in 24% of patients: 10% were classified as "Risk," 10% as "Injury," and 4% as "Failure." Patients with AKI had significantly longer durations of mechanical ventilation, ICU and hospital stays, and higher mortality rates. Independent risk factors for AKI included prolonged CPB time (>120 minutes), age<6 months, preoperative pulmonary hypertension, low preoperative serum albumin (<3.5 g/dL), STAT score≥3, red blood cell transfusion>50 mL/kg, and inotrope score≥8.
Conclusion: AKI is a frequent and serious complication after congenital heart surgery. Several modifiable and non-modifiable risk factors contribute to its development, emphasizing the need for early risk stratification and preventive strategies in high-risk pediatric patients.