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Outcomes of adults with congenital heart disease that experience acute kidney injury in the intensive care unit

Published online by Cambridge University Press:  16 November 2020

Dana Y. Fuhrman Open the ORCID record for Dana Y. Fuhrman [Opens in a new window] ,
Lan Nguyen ,
Emily L. Joyce ,
Priyanka Priyanka  and
John A. Kellum
Dana Y. Fuhrman*
Affiliation:
Department of Critical Care Medicine, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Pediatrics, Division of Pediatric Nephrology, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
Lan Nguyen
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA
Emily L. Joyce
Affiliation:
Department of Pediatrics, Division of Pediatric Nephrology, Rainbow Babies and Children’s Hospital, Cleveland, OH, USA
Priyanka Priyanka
Affiliation:
Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
John A. Kellum
Affiliation:
Department of Critical Care Medicine, University of Pittsburgh, Medical Center Children’s Hospital of Pittsburgh, Children’s Hospital Drive, Pittsburgh, PA, USA Department of Critical Care Medicine, The Center for Critical Care Nephrology, Pittsburgh, PA, USA
*
Author for correspondence: Dr D. Y. Fuhrman, DO, MS, University of Pittsburgh Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Children’s Hospital Drive, Faculty Pavilion, Suite 2000, Pittsburgh 15224, PA, USA. Tel: +1 412-692-5164; Fax: +1 412-692-6076. E-mail: [email protected]
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Abstract

Background:

Young adults with congenital heart disease (CHD) are increasing in number with an increased risk for acute kidney injury. Little is known concerning the impact of non-recovery of kidney function for these patients. Therefore, we sought to explore the rates of acute kidney disease, persistent renal dysfunction, and their associations with adverse outcomes in young adults with CHD.

Methods:

This is a single-centre retrospective study including all patients at the ages of 18–40 with CHD who were admitted to an intensive care unit between 2010 and 2014. Patients with a creatinine ≥ 1.5 times the baseline at the time of hospital discharge were deemed to have persistent renal dysfunction, while acute kidney disease was defined as a creatinine ≥ 1.5 times the baseline 7–28 days after a diagnosis of acute kidney injury. Outcomes of death at 5 years and length of hospital stay were examined using multivariable logistic regression and negative binomial regression, respectively.

Results:

Of the (89/195) 45.6% of patients with acute kidney injury, 33.7% had persistent renal dysfunction and 23.6% met the criteria for acute kidney disease. Persistent renal dysfunction [odds ratio (OR), 3.27; 95% confidence interval (CI): 1.15–9.29] and acute kidney disease (OR: 11.79; 95% CI: 3.75–39.09) were independently associated with mortality at 5 years. Persistent renal dysfunction was associated with a longer duration of hospital stay (Incidence Rate Ratio: 1.96; 95% CI: 1.53–2.51).

Conclusions:

In young adults with CHD, acute kidney injury was common and persistent renal dysfunction, as well as acute kidney disease, were associated with increased mortality and length of hospitalisation.

Keywords

Congenital heart diseaseacute kidney injuryacute kidney diseasecardiac surgery
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 2 , February 2021 , pp. 274 - 278
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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