Ueno Kentaro, Seki Shunji, Shiokawa Naohiro, Matsuba Tomoyuki, Miyazono Akinori, Hazeki Daisuke, Imoto Yutaka, Kawano Yoshifumi
Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Nephrology (Carlton). 2019 Mar;24(3):294-300. doi: 10.1111/nep.13240.
We aimed to validate the incidence of, risk factors for, and postoperative outcomes of acute kidney injury (AKI) according to the modified Kidney Disease Improving Global Outcomes (m-KDIGO) criteria and compare this criteria with both the paediatric Risk, Injury, Failure, Loss, End-stage disease (pRIFLE) and Acute Kidney Injury Network (AKIN) criteria in infants after cardiac surgery.
We retrospectively enrolled 145 consecutive infants who underwent open-heart surgery at Kagoshima University Hospital.
Acute kidney injury was present in 55 (37.9%), 111 (75.9%), and 95 (65.5%) patients according to the m-KDIGO, pRIFLE, and AKIN criteria, respectively. Among these, 71.9% of patients pRIFLE Risk patients and 60.5% of AKIN 1 patients were categorized in the 'no-AKI' group according to the m-KDIGO criteria. Low body weight (m-KDIGO odds ratio [OR], 0.73; P = 0.015; pRIFLE OR, 0.66; P = 0.001; AKIN OR 0.69, P = 0.002) and prolonged cross-clamp time (m-KDIGO OR, 1.02; <P = 0.001; pRIFLE OR, 1.02; P = 0.003; AKIN OR, 1.02; P = 0.001) were independent risk factors for the development of AKI. Further, m-KDIGO-based AKI grade was more strongly associated with higher incidence of requiring renal replacement therapy and mortality than both the pRIFLE- and AKIN- based AKI grade.
Application of the three criteria resulted in different AKI incidences, but each criterion could be useful for detecting risk factors for AKI. Notably, using m-KDIGO criteria provides more important subsequent postoperative outcomes. The m-KDIGO AKI criteria describe clinically relevant AKI in infants after cardiac surgery.
我们旨在根据改良的改善全球肾脏病预后组织（m-KDIGO）标准验证心脏手术后婴儿急性肾损伤（AKI）的发病率、危险因素及术后结局，并将该标准与儿科风险、损伤、衰竭、失功、终末期肾病（pRIFLE）标准和急性肾损伤网络（AKIN）标准进行比较。
我们回顾性纳入了145例在鹿儿岛大学医院接受心脏直视手术的连续婴儿。
根据m-KDIGO、pRIFLE和AKIN标准，分别有55例（37.9%）、111例（75.9%）和95例（65.5%）患者发生急性肾损伤。其中，根据m-KDIGO标准，71.9%的pRIFLE风险患者和60.5%的AKIN 1期患者被归类为“无AKI”组。低体重（m-KDIGO比值比[OR]，0.73；P = 0.015；pRIFLE OR，0.66；P = 0.001；AKIN OR 0.69，P = 0.002）和延长的主动脉阻断时间（m-KDIGO OR，1.02；P < 0.001；pRIFLE OR，1.02；P = 0.003；AKIN OR，1.02；P = 0.001）是AKI发生的独立危险因素。此外，与基于pRIFLE和AKIN的AKI分级相比，基于m-KDIGO的AKI分级与需要肾脏替代治疗的更高发生率和死亡率的相关性更强。
应用这三种标准导致了不同的AKI发病率，但每种标准都有助于检测AKI的危险因素。值得注意的是，使用m-KDIGO标准能提供更重要的术后后续结局。m-KDIGO AKI标准描述了心脏手术后婴儿临床上相关的AKI情况。
