TY - JOUR
T1 - Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass
AU - Kim-Campbell, Nahmah
AU - Gretchen, Catherine
AU - Callaway, Clifton
AU - Felmet, Kathryn
AU - Kochanek, Patrick M.
AU - Maul, Timothy
AU - Wearden, Peter
AU - Sharma, Mahesh
AU - Viegas, Melita
AU - Munoz, Ricardo
AU - Gladwin, Mark T.
AU - Bayir, Hülya
N1 - Publisher Copyright:
Copyright © 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
PY - 2017/11/1
Y1 - 2017/11/1
N2 - Objectives: To determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery. Design: Prospective observational study. Setting: Twelve-bed cardiac ICU in a university-affiliated children’s hospital. Patients: Children were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction. Interventions: None. Measurements and Main Results: Plasma and urine were collected at baseline (in a subset), the beginning and end of cardiopulmonary bypass, and 2 hours and 24 hours after cardiopulmonary bypass in 60 subjects. Levels of plasma hemoglobin increased during cardiopulmonary bypass and were associated (p < 0.01) with cardiopulmonary bypass duration (R2 = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R2 = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R2 = 0.27), and change in creatinine (R2 = 0.12). Forty-three percent of patients developed acute kidney injury. There was an association between plasma hemoglobin level and change in creatinine that varied by age (overall [R2 = 0.12; p < 0.01]; in age > 2 yr [R2 = 0.22; p < 0.01]; and in < 2 yr [R2 = 0.03; p = 0.42]). Change in plasma hemoglobin and male gender were found to be risk factors for acute kidney injury (odds ratio, 1.02 and 3.78, respectively; p < 0.05). Conclusions: Generation of plasma hemoglobin during cardiopulmonary bypass and male gender are associated with subsequent renal dysfunction in low-risk pediatric patients, especially in those older than 2 years. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing cardiopulmonary bypass would benefit from potential treatments for hemolysis and plasma hemoglobin–associated renal dysfunction.
AB - Objectives: To determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery. Design: Prospective observational study. Setting: Twelve-bed cardiac ICU in a university-affiliated children’s hospital. Patients: Children were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction. Interventions: None. Measurements and Main Results: Plasma and urine were collected at baseline (in a subset), the beginning and end of cardiopulmonary bypass, and 2 hours and 24 hours after cardiopulmonary bypass in 60 subjects. Levels of plasma hemoglobin increased during cardiopulmonary bypass and were associated (p < 0.01) with cardiopulmonary bypass duration (R2 = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R2 = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R2 = 0.27), and change in creatinine (R2 = 0.12). Forty-three percent of patients developed acute kidney injury. There was an association between plasma hemoglobin level and change in creatinine that varied by age (overall [R2 = 0.12; p < 0.01]; in age > 2 yr [R2 = 0.22; p < 0.01]; and in < 2 yr [R2 = 0.03; p = 0.42]). Change in plasma hemoglobin and male gender were found to be risk factors for acute kidney injury (odds ratio, 1.02 and 3.78, respectively; p < 0.05). Conclusions: Generation of plasma hemoglobin during cardiopulmonary bypass and male gender are associated with subsequent renal dysfunction in low-risk pediatric patients, especially in those older than 2 years. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing cardiopulmonary bypass would benefit from potential treatments for hemolysis and plasma hemoglobin–associated renal dysfunction.
KW - acute kidney injury
KW - cardiopulmonary bypass
KW - cell-free plasma hemoglobin
KW - hemolysis
KW - pediatrics
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U2 - 10.1097/CCM.0000000000002703
DO - 10.1097/CCM.0000000000002703
M3 - Article
C2 - 28863013
AN - SCOPUS:85032161816
SN - 0090-3493
VL - 45
SP - E1123-E1130
JO - Critical care medicine
JF - Critical care medicine
IS - 11
ER -