Incidence, risk factors and clinical outcomes for acute kidney injury after aortic arch repair in paediatric patients.

Objectives: Acute kidney injury (AKI) is common after paediatric cardiac surgery and associated with increased morbidity and mortality. Aortic arch surgery may be an independent risk factor for AKI because of circulatory arrest below the descending thoracic artery during anastomosis. We investigated the surgical outcomes associated with AKI after aortic arch repair in paediatric patients.

Methods: We retrospectively analysed 120 paediatric patients who underwent aortic arch repair between 2003 and 2012. AKI was defined according to the paediatric-modified risk, injury, failure, loss and end-stage kidney disease criteria. The incidence, clinical outcomes and risk factors for AKI were analysed.

Results: Aortic arch repair was performed for coarctation of aorta in 97 patients and interrupted aortic arch in 23 patients. The median age and body weight at the time of surgery were 16.5 days and 3.3 kg, respectively. The mean duration of the follow-up was 3.9 years. AKI developed in 42 patients (36.8%) and peritoneal dialysis (PD) was applied in 20 patients (16.7%). The recovery of renal function began a mean of 3.8 days after conservative management, and full recovery occurred a mean of 6.7 days after conservative management. A lower body weight (<3.0 kg) (odds ratio [OR]: 7.569, P = 0.009) and the absence of prerenal impairment (OR: 9.876, P = 0.041) were shown to be independent risk factors. Patients who required PD had prolonged intensive care unit and hospital stays (P = 0.002 and P = 0.003).

Conclusions: AKI is common in low-birth-weight patients after aortic arch repair surgery. However, patients recover from AKI after conservative management. Requiring PD increases the morbidity associated with AKI.