Pediatrik Kalp Cerrahisi Sonrası Gelişen Akut Böbrek Hasarının “Pediatrik Rıfle Kriterleri” Kullanılarak Değerlendirilmesi

Abstract

Giriş: Pediatrik kalp cerrahisi uygulanan hastalarda, postoperatif akut böbrek hasarının belirlenmesi ve mevcut hasarın derecesinin evrelenmesi için pRIFLE sınıflaması kullanılması ile bu hasta grubu ve böbrek hasarı olmayan hasta grupları arasında postoperatif sonuçların karşılaştırılması amaçlanmıştır.

Hastalar ve Yöntem: Nisan 2012 ile Nisan 2013 tarihleri arasında kliniğimizde konjenital kalp hastalığı nedeniyle ameliyat edilen tüm hastalar geriye dönük olarak incelendi. Akut böbrek hasarının belirlenmesi ve evrelenmesi için pRIFLE kriterleri kullanıldı. Primer olarak önem verilen sonuçlar, postoperatif dönemde akut böbrek hasarı gelişen olguların pRIFLE kriterleri ile belirlenmesi, hasar derecesinin pRIFLE evreleri ile gösterilmesi, böbrek hasarı olguları ile böbrek hasarı olmayan olgular arasında operatif verilerin ve postoperatif sonuçların karşılaştırılması idi.

Bulgular: Çalışmaya ardışık 105 hasta dahil edildi. Akut böbrek hasarı tespit edilen 45 (%42.9) hasta grup 1 olarak, diğerleri grup 2 olarak tanımlandı. Preoperatif verilerden ortalama yaş grup 1’de anlamlı olarak düşüktü (p= 0.001). Operatif verilerden kardiyopulmoner baypas süresi grup 1’de anlamlı olarak yüksekti (p= 0.04) ve hipotermi anlamlı olarak düşüktü (p= 0.001). Postoperatif dönemde, mortalite açısından gruplar arasında istatistiksel anlamlı fark gözlenmedi (p= 0.65). Hastaların mekanik ventilasyon ve yoğun bakım kalış süreleri, grup 1’de anlamlı olarak yüksek (sırasıyla p= 0.004 ve 0.04) iken, hastane kalış süreleri açısından gruplar arasında fark yoktu (p= 0.53).

Sonuç: Pediatrik kalp cerrahisi uygulanan hastalarda postoperatif dönemde akut böbrek hasarı gelişme riski yüksektir ve bu durum postoperatif sonuçları etkilemektedir. Bu nedenle perioperatif dönemde bu hasardan korunma ve erken dönemde müdahale yönetiminin gerçekleştirilmesi için hasarın öngörüsünün yapılması amacıyla neredeyse maliyetsiz, kolay ve hızlı sonuç alınan pRIFLE kriterlerinin kullanılmasını önermekteyiz.

Keywords

• Akut böbrek hasarı,konjenital kalp hastalıkları,pRIFLE kriterleri

The Evaluation of Acute Kidney Injury After Pediatric Heart Surgery By Using “Pediatric RIFLE Criteria”

Abstract

Introduction: The aim of this study was to use pRIFLE classification for the determination and staging of postoperative acute kidney injury in patients undergoing pediatric cardiac surgery and to compare of postoperative results between patients with and without kidney injury.

Patients and Methods: Between April 2012 and 2013, all patients undergoing congenital heart surgery were retrospectively reviewed. pRIFLE criteria were used for the determination and staging of acute kidney injury. Primary outcome of interest was the determination and staging of acute kidney injury in the postoperative period by pRIFLE criteria and the comparison of postoperative results between patients with and without kidney injury.

Results: Hundred and five consecutive patients were included in this study. Forty-five (42.9%) patients with acute kidney injury were defined as group 1 and others as group 2. Mean age was significantly lower in group 1 (p= 0.001). According to the operative data, the mean cardiopulmonary bypass time was significantly higher (p= 0.04) and the hypothermia was significantly lower in group 1 (p= 0.001). No statistically significant difference was observed between the groups in terms of mortality (p= 0.65). The mean duration of mechanical ventilation and intensive care unit stay was significantly higher in group 1 (p= 0.004 and p= 0.04, respectively), but there was no difference between the groups in terms of hospital stay (p= 0.53).

Conclusion: There is a high risk of developing acute kidney injury in patients undergoing congenital cardiac surgery and it may affect postoperative outcomes. For this reason, we recommend the use of pRIFLE criteria which are almost costless, easy, and fast, to predict the renal damage for early detection and intervention in acute kidney injury.

Keywords

• Acute kidney injury,congenital heart diseases,pRIFLE criteria

References

1. 1. Dittrich S, Kurschat K, Dähnert I, Vogel M, Müller C, Alexi-Meskishvii V, et al. Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol 2000;73:173-9.
2. 2. Gist KM, Kwiatkowski DM, Cooper DS. Acute kidney injury in congenital heart disease. Curr Opin Cardiol 2018;33:101-7.
3. 3. Eknoyan G. Emergence of the concept of acute renal failure. Am J Nephrol 2002;22:225-30.
4. 4. Mehta RL, Pascual MT, Soroko S, Savage BT, Himmelfarb J, Ikizler TA, et al. Spectrum of acute renal failure in the intensive care unit: The PICARD experience. Kidney Int 2004; 66:1613-21.
5. 5. Palevsky PM. Epidemiology of acute renal failure: The tip of the iceberg. Clin J Am Soc Nephrol 2006;1:6-7.
6. 6. Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality grom acute renal failure decreased? A systematic review of the literatüre. Am J Med 2005;118:827-32.
7. 7. Metnitz PG, Krenn CG, Steltzer H, Lang T, Ploder J, Lenz K, et al. Effect of acute renal failure requiring renal replacement therapy on outcome in critically ill patients. Crit Care Med 2002;30:2051-8.
8. 8. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute kidney injury network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.

9. 9. Makris K, Spanou L. Acute kidney injury: Definition, pathophysiology and clinical phenotypes. Clin Biochem Rev 2016;37:85-98.
10. 10. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute dialysis quality initiative workgroup. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: The Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204-12.
11. 11. Kellum JA, Ronco C. Controversies in acute kidney injury: The 2011 Brussels Roundtable. Crit Care 2011;15:155.
12. 12. Akcan-Arikan A, Zapitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.
13. 13. Peco-Antić A, Ivanišević I, Vulićević I, Kotur-Stevuljević J, Ilić S, Ivanišević J, et al. Biomarkers of acute kidney injury in pediatric cardiac surgery. Clin Biochem 2013;46:1244-51.
14. 14. Schwartz GJ, Haycock GB, Edelman CM, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58:259-63.
15. 15. Feng Y, Zhang Y, Li G, Wang L. Relationship of cystatin-C change and the prevalence of death or dialysis need after acute kidney injury: a meta-analysis. Nephrology (Carlton) 2014;19:679-84.
16. 16. Zhang Z, Lu B, Sheng X, Jin N. Cystatin C in prediction of acute kidney injury: a systemic review and meta-analysis. Am J Kidney Dis 2011;58:356-65.
17. 17. Haase M, Bellomo R, Devarajan P, Schlattmann P, Haase-Fielitz A. Accuracy of neutrophil gelatinase-associated lipocalin (NGAL) in diagnosis and prognosis in acute kidney injury: a systematic review and meta-analysis. Am J Kidney Dis 2009;54:1012-24.
18. 18. Haase-Fielitz, Haase M, Devarajan P. Neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury: a critical evaluation of current status. Ann Clin Biochem 2014;51:335-51.
19. 19. Zhou F, Luo Q, Wang L, Han L. Diagnostic value of neutrophil gelatinase-associated lipocalin for early diagnosis of cardiac surgery-associated acute kidney injury: a meta-analysis. Eur J Cardiothorac Surg 2016;49:746-55.
20. 20. Singh SP. Acute kidney injury after pediatric cardiac surgery. Ann Card Anaesth 2016;19:306-13.
21. 21. Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 2011;39:1493-9.
22. 22. Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, et al. Congenital heart surgery in infants: Effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012;143:368-74.
23. 23. Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, et al. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012;94:1589-95.
24. 24. Lannemyr L, Bragadottir G, Krumbholz V, Redfors B, Sellgren J, Ricksten SE. Effects of cardiopulmonary bypass on renal perfusion, filtration, and oxygenation in patients undergoing cardiac surgery. Anesthesiology 2017;126:205-13.
25. 25. Amini S, Abbaspour H, Morovatdar N, Robabi HN, Soltani G, Tashnizi MA. Risk factors and outcome of acute kidney injury after congenital heart surgery: a prospective observational study. Indian J Crit Med 2017;21:847-51.
26. 26. Bennett M, Dent CL, Ma Q, Dastrala S, Grenier F, Workman R, et al. Urine NGAL predicts severity of acute kidney injury after cardiac surgery: a prospective study. Clin J Am Soc Nephrol 2008;3:665-73.
27. 27. Sethi SK, Goyal D, Yadav DK, Shukla U, Kajala PL, Gupta VK, et al. Predictors of acute kidney injury post-cardiopulmonary bypass in children. Clin Exp Nephrol 2011;15:529-34.
28. 28. Demirkıran O. Kritik hastalarda renal replasmanı tedavisi. Türkiye Klinikleri Anesteziyoloji Reanimasyon-Ozel Konular 2012;5:64-74.