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 journalArticle

5 Citations (Scopus)

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.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 (R = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R = 0.27), and change in creatinine (R = 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 [R = 0.12; p < 0.01]; in age > 2 yr [R = 0.22; p < 0.01]; and in < 2 yr [R = 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

Fingerprint

Plasma Cells
Cardiopulmonary Bypass
Acute Kidney Injury
Hemoglobins
Kidney
Pediatrics
Hemolysis
Thoracic Surgery
Observational Studies
Appointments and Schedules
Outpatients
Odds Ratio
Urine
Prospective Studies

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass. / Kim-Campbell, Nahmah; Gretchen, Catherine; Callaway, Clifton; Felmet, Kathryn; Kochanek, Patrick M.; Maul, Timothy; Wearden, Peter; Sharma, Mahesh; Viegas, Melita; Munoz, Ricardo; Gladwin, Mark T.; Bayir, Hülya.

In: Critical Care Medicine, Vol. 45, No. 11, 01.11.2017, p. e1123-e1130.

Research output: Contribution to journalArticle

Kim-Campbell, N, Gretchen, C, Callaway, C, Felmet, K, Kochanek, PM, Maul, T, Wearden, P, Sharma, M, Viegas, M, Munoz, R, Gladwin, MT & Bayir, H 2017, 'Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass', Critical Care Medicine, vol. 45, no. 11, pp. e1123-e1130. https://doi.org/10.1097/CCM.0000000000002703
Kim-Campbell, Nahmah ; Gretchen, Catherine ; Callaway, Clifton ; Felmet, Kathryn ; Kochanek, Patrick M. ; Maul, Timothy ; Wearden, Peter ; Sharma, Mahesh ; Viegas, Melita ; Munoz, Ricardo ; Gladwin, Mark T. ; Bayir, Hülya. / Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass. In: Critical Care Medicine. 2017 ; Vol. 45, No. 11. pp. e1123-e1130.
@article{34c93bb167c04487b567e4d9bd9d1f98,
title = "Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass",
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.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 (R = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R = 0.27), and change in creatinine (R = 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 [R = 0.12; p < 0.01]; in age > 2 yr [R = 0.22; p < 0.01]; and in < 2 yr [R = 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.",
author = "Nahmah Kim-Campbell and Catherine Gretchen and Clifton Callaway and Kathryn Felmet and Kochanek, {Patrick M.} and Timothy Maul and Peter Wearden and Mahesh Sharma and Melita Viegas and Ricardo Munoz and Gladwin, {Mark T.} and H{\"u}lya Bayir",
year = "2017",
month = "11",
day = "1",
doi = "10.1097/CCM.0000000000002703",
language = "English (US)",
volume = "45",
pages = "e1123--e1130",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

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

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.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 (R = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R = 0.27), and change in creatinine (R = 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 [R = 0.12; p < 0.01]; in age > 2 yr [R = 0.22; p < 0.01]; and in < 2 yr [R = 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.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 (R = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R = 0.27), and change in creatinine (R = 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 [R = 0.12; p < 0.01]; in age > 2 yr [R = 0.22; p < 0.01]; and in < 2 yr [R = 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.

UR - http://www.scopus.com/inward/record.url?scp=85032161816&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032161816&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000002703

DO - 10.1097/CCM.0000000000002703

M3 - Article

C2 - 28863013

AN - SCOPUS:85032161816

VL - 45

SP - e1123-e1130

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 11

ER -