Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

Nahmah Kim-Campbell, Catherine Gretchen, Clifton Callaway, Kathryn Felmet, Patrick M. Kochanek, Timothy Maul, Peter Wearden, Mahesh Sharma, Melita Viegas, Ricardo Munoz, Mark T. Gladwin, Hülya Bayir

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)E1123-E1130
JournalCritical care medicine
Volume45
Issue number11
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Keywords

  • acute kidney injury
  • cardiopulmonary bypass
  • cell-free plasma hemoglobin
  • hemolysis
  • pediatrics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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