Acute Kidney Injury Risk in Pediatric Patients Undergoing Heart Surgery

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The researchers found a correlation between the magnitude of nadir platelet counts and severity of acute kidney injury.
The researchers found a correlation between the magnitude of nadir platelet counts and severity of acute kidney injury.

HealthDay News – For pediatric patients undergoing cardiopulmonary bypass (CPB), postoperative nadir platelet counts are associated with the severity of acute kidney injury (AKI), according to a review published online in Pediatric Anesthesia.

Shannon Tew, MD, from Camelback Anesthesiology Consultants in Tempe, Arizona, and colleagues conducted a retrospective review of medical records and database for a single institution over a 5-year period for 814 patients younger than 21 years of age undergoing cardiac surgery with CPB. They captured demographics, laboratory, and surgical characteristics, and recorded clinical event rates.

The researchers observed a 48% decrease in postoperative platelet counts from baseline, reaching a mean nadir value of 150 × 109 L−1 on postoperative day 3. A total of 37% of patients had AKI, including 13%, 17%, and 6%, respectively, with Acute Kidney Injury Network stages 1, 2, and 3. There was a correlation for the magnitude of nadir platelet counts and the severity of AKI. Nadir platelet counts, CPB time, Aristotle score, patient weight, intraoperative packed red blood cell transfusion, and having a heart transplant procedure were independent predictors of AKI severity.

"In pediatric open-heart surgery, thrombocytopenia and AKI occur commonly following CPB," the authors wrote. "Our findings show a strong association between nadir platelet counts and the severity of AKI."

Reference

Tew S, Fontes ML, Greene NH, et al. Natural history of nonimmune-mediated thrombocytopenia and acute kidney injury in pediatric open-heart surgery [Published online January 18, 2017]. Paediatr Anaesth. doi:10.1111/pan.13063

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