Marosi Anna, Conway Jennifer, Morgan Catherine, Yaskina Maryna, Foshaug Rae, Chappell Alyssa, Ryerson Lindsay, Martin Billie-Jean, Ash Alanna, Al-Aklabi Mohammed, Myers Kim, Mackie Andrew S
Faculty of Science, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
JTCVS Open. 2023 Nov 30;17:248-256. doi: 10.1016/j.xjon.2023.11.015. eCollection 2024 Feb.
Acute kidney injury has been described after Fontan surgery, but the duration and outcomes are unknown. We sought to describe the incidence of and risk factors for acute kidney injury and the phenotype of renal recovery, and evaluate the impact of renal recovery phenotype on outcomes.
All children who underwent a Fontan operation at a single center between 2009 and 2022 were included. Data collected included Fontan characteristics, vasopressor use, all measures of creatinine, and postoperative outcomes. Logistic regression models were used to assess predictors of acute kidney injury and the association between acute kidney injury and outcomes.
We enrolled 141 children (45% female). Acute kidney injury occurred in 100 patients (71%). Acute kidney injury duration was transient (<48 hours) in 77 patients (55%), persistent (2-7 days) in 15 patients (11%), more than 7 days in 4 patients (3%), and unknown in 4 patients (3%). Risk factors for acute kidney injury included higher preoperative indexed pulmonary vascular resistance (odds ratio, 3.90; = .004) and higher postoperative inotrope score on day 0 (odds ratio, 1.13, = .047). Risk factors for acute kidney injury duration more than 48 hours included absence of a fenestration (odds ratio, 3.43, = .03) and longer duration of cardiopulmonary bypass (odds ratio, 1.22 per 15-minute interval, = .01). Acute kidney injury duration more than 48 hours was associated with longer length of stay compared with transient acute kidney injury (median 18 days [interquartile range, 9-62] vs 10 days [interquartile range, 8-16], = .006) and more sternal wound infections (17% vs 4%, = .049).
Acute kidney injury after the Fontan operation is common. The occurrence and duration of acute kidney injury have significant implications for postoperative outcomes.
Fontan手术后曾有急性肾损伤的相关描述，但损伤持续时间及预后尚不清楚。我们试图描述急性肾损伤的发生率、危险因素及肾脏恢复的表型，并评估肾脏恢复表型对预后的影响。
纳入2009年至2022年间在单一中心接受Fontan手术的所有儿童。收集的数据包括Fontan手术特征、血管活性药物使用情况、所有肌酐测量值及术后结局。采用逻辑回归模型评估急性肾损伤的预测因素以及急性肾损伤与结局之间的关联。
我们纳入了141名儿童（45%为女性）。100例患者（71%）发生了急性肾损伤。77例患者（55%）的急性肾损伤持续时间为短暂性（<48小时），15例患者（11%）为持续性（2 - 7天），4例患者（3%）超过7天，4例患者（3%）情况不明。急性肾损伤的危险因素包括术前较高的肺血管阻力指数（比值比，3.90；P = 0.004）及术后第0天较高的血管活性药物评分（比值比，1.13，P = 0.047）。急性肾损伤持续时间超过48小时的危险因素包括无开窗（比值比，3.43，P = 0.03）及体外循环时间更长（每延长15分钟，比值比为1.22，P = 0.01）。与短暂性急性肾损伤相比，急性肾损伤持续时间超过48小时与住院时间延长相关（中位数18天[四分位间距，9 - 62]对10天[四分位间距，8 - 16]，P = 0.006），且胸骨伤口感染更多（17%对4%，P = 0.049）。
Fontan手术后急性肾损伤很常见。急性肾损伤的发生及持续时间对术后结局有重大影响。
