Contrast media exposure in the perioperative period confers no additional risk of acute kidney injury in infants and young children undergoing cardiac surgery with cardiopulmonary bypass

Abstract

Background

Recently, there has been an interest in the temporal relationship between contrast exposure (CM) and cardiac surgery suggesting that a “double hit” on the kidney function in close succession increases the risk of acute kidney injury (AKI) after cardiac surgery. However, data from young children is limited. The purpose of this study was to retrospectively evaluate the effects of preoperative CM exposure on postoperative AKI in infant and young children patients and to further analyze the influence of exposure time interval.

Methods

Patients (age ≤ 3 years) who underwent diagnostic imaging within 14 days before on-pump cardiac surgery between 1 May 2017 and 31 May 2018 in Fuwai Hospital, Beijing, were analyzed. Kidney outcome was assessed according to Kidney Disease: Improving Global Outcomes creatinine-based criteria.

Results

One thousand four hundred pediatric patients (192 CM and 1,248 non-CM) were identified. Postoperative AKI occurred in 57 (29.7%) of the 192 patients who were exposed to CM. Following propensity score adjustment, no difference in risk for AKI was observed between the CM and non-CM groups (RR 1.142, 95% CI 0.916–1.424; P = 0.264). Multivariable logistic regression of the CM group indicated that independent predictors of postoperative AKI were lower weight, lower preoperative creatinine level, and longer CPB duration. Time interval between CM exposure and on-pump cardiac surgery was not significantly associated with increased risk of AKI (OR 0.853, 95% CI 0.265~2.747; P = 0.790).

Conclusions

For pediatric patients who are soon to undergo on-pump cardiac procedures, there appears to be no need to hesitate in performing the diagnostic imaging investigations requiring CM, or delay CPB after CM exposure. These patients may benefit from increased diagnostic utility without increasing their risk of postoperative AKI.

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References

  1. 1.

    Blinder JJ, Goldstein SL, Lee V-V, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374. https://doi.org/10.1016/j.jtcvs.2011.06.021

    Article  PubMed  Google Scholar 

  2. 2.

    Li S, Krawczeski CD, Zappitelli M, Devarajan P, Thiessen-Philbrook H, Coca SG, Kim RW, Parikh CR (2011) Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med 39:1493–1499. https://doi.org/10.1097/CCM.0b013e31821201d3

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Aydin SI, Seiden HS, Blaufox AD, Parnell VA, Choudhury T, Punnoose A, Schneider J (2012) Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94:1589–1595. https://doi.org/10.1016/j.athoracsur.2012.06.050

    Article  PubMed  Google Scholar 

  4. 4.

    Morgan CJ, Zappitelli M, Robertson CMT, Alton GY, Sauve RS, Joffe AR, Ross DB, Rebeyka IM (2013) Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 162:120–127.e121. https://doi.org/10.1016/j.jpeds.2012.06.054

    Article  PubMed  Google Scholar 

  5. 5.

    Greenberg JH, Zappitelli M, Devarajan P, Thiessen-Philbrook HR, Krawczeski C, Li S, Garg AX, Coca S, Parikh CR (2016) kidney outcomes 5 years after pediatric cardiac surgery: the TRIBE-AKI Study. JAMA Pediatr 170:1071–1078. https://doi.org/10.1001/jamapediatrics.2016.1532

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Hu Y, Li Z, Chen J, Shen C, Song Y, Zhong Q (2013) The effect of the time interval between coronary angiography and on-pump cardiac surgery on risk of postoperative acute kidney injury: a meta-analysis. J Cardiothorac Surg 8:178. https://doi.org/10.1186/1749-8090-8-178

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Jiang W, Yu J, Xu J, Shen B, Wang Y, Luo Z, Wang C, Ding X, Teng J (2018) Impact of cardiac catheterization timing and contrast media dose on acute kidney injury after cardiac surgery. BMC Cardiovasc Disord 18:191. https://doi.org/10.1186/s12872-018-0928-8

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Mariscalco G, Cottini M, Dominici C, Banach M, Piffaretti G, Borsani P, Bruno VD, Corazzari C, Gherli R, Beghi C (2014) The effect of timing of cardiac catheterization on acute kidney injury after cardiac surgery is influenced by the type of operation. Int J Cardiol 173:46–54. https://doi.org/10.1016/j.ijcard.2014.02.010

    Article  PubMed  Google Scholar 

  9. 9.

    Ranucci M, Ballotta A, Agnelli B, Frigiola A, Menicanti L, Castelvecchio S (2013) Acute kidney injury in patients undergoing cardiac surgery and coronary angiography on the same day. Ann Thorac Surg 95:513–519. https://doi.org/10.1016/j.athoracsur.2012.09.012

    Article  Google Scholar 

  10. 10.

    Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI (2002) Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 123:110–118. https://doi.org/10.1067/mtc.2002.119064

    Article  PubMed  Google Scholar 

  11. 11.

    Koponen T, Karttunen J, Musialowicz T, Pietiläinen L, Uusaro A, Lahtinen P (2019) Vasoactive-inotropic score and the prediction of morbidity and mortality after cardiac surgery. Br J Anaesth 122:428–436. https://doi.org/10.1016/j.bja.2018.12.019

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    KDIGO (2012) KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2:1–138

  13. 13.

    Brown KL, Ridout D, Pagel C, Wray J, Anderson D, Barron DJ, Cassidy J, Davis PJ, Rodrigues W, Stoica S, Tibby S, Utley M, Tsang VT (2019) Incidence and risk factors for important early morbidities associated with pediatric cardiac surgery in a UK population. J Thorac Cardiovasc Surg 158:1185–1196.e1187. https://doi.org/10.1016/j.jtcvs.2019.03.139

    Article  PubMed  Google Scholar 

  14. 14.

    Jang WS, Kim W-H, Choi K, Nam J, Jung JC, Kwon BS, Kim GB, Kang HG, Lee JR, Kim YJ (2014) Incidence, risk factors and clinical outcomes for acute kidney injury after aortic arch repair in paediatric patients. Eur J Cardiothorac Surg 45:e208–e214. https://doi.org/10.1093/ejcts/ezu132

    Article  PubMed  Google Scholar 

  15. 15.

    Lee SH, Kim S-J, Kim HJ, Son JS, Lee R, Yoon TG (2017) Acute kidney injury following cardiopulmonary bypass in children - risk factors and outcomes. Circ J 81:1522–1527. https://doi.org/10.1253/circj.CJ-17-0075

    Article  PubMed  Google Scholar 

  16. 16.

    Park S-K, Hur M, Kim E, Kim WH, Park JB, Kim Y, Yang J-H, Jun T-G, Kim CS (2016) Risk factors for acute kidney injury after congenital cardiac surgery in infants and children: a retrospective observational study. PLoS One 11:e0166328. https://doi.org/10.1371/journal.pone.0166328

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Bedoya MA, White AM, Edgar JC, Pradhan M, Raab EL, Meyer JS (2017) Effect of Intravenous administration of contrast media on serum creatinine levels in neonates. Radiology 284:530–540. https://doi.org/10.1148/radiol.2017160895

    Article  PubMed  Google Scholar 

  18. 18.

    McDonald JS, McDonald RJ, Tran CL, Kolbe AB, Williamson EE, Kallmes DF (2018) Postcontrast acute kidney injury in pediatric patients: a cohort study. Am J Kidney Dis 72:811–818. https://doi.org/10.1053/j.ajkd.2018.05.014

    Article  PubMed  Google Scholar 

  19. 19.

    Gilligan LA, Davenport MS, Trout AT, Su W, Zhang B, Goldstein SL, Dillman JR (2020) Risk of acute kidney injury following contrast-enhanced ct in hospitalized pediatric patients: a propensity score analysis. Radiology 294:548–556. https://doi.org/10.1148/radiol.2020191931

    Article  PubMed  Google Scholar 

  20. 20.

    Bianchi P, Carboni G, Pesce G, Isgrò G, Carlucci C, Frigiola A, Giamberti A, Ranucci M (2013) Cardiac catheterization and postoperative acute kidney failure in congenital heart pediatric patients. Anesth Analg 117:455–461. https://doi.org/10.1213/ANE.0b013e318299a7da

    Article  PubMed  Google Scholar 

  21. 21.

    Huggins N, Nugent A, Modem V, Rodriguez JS, Forbess J, Scott W, Dimas VV (2014) Incidence of acute kidney injury following cardiac catheterization prior to cardiopulmonary bypass in children. Catheter Cardiovasc Interv 84:615–619. https://doi.org/10.1002/ccd.25405

    Article  PubMed  Google Scholar 

  22. 22.

    Carlo WF, Clark ST, Borasino S, Alten JA (2017) Impact of contrast exposure from computed tomography angiography on acute kidney injury after neonatal cardiopulmonary bypass surgery. Congenit Heart Dis 12:540–545. https://doi.org/10.1111/chd.12482

    Article  Google Scholar 

  23. 23.

    Prasad A (2014) Acute kidney injury following contrast administration in pediatric congenital heart disease patients: time to move beyond the serum creatinine. Catheter Cardiovasc Interv 84:620–621. https://doi.org/10.1002/ccd.25637

    Article  PubMed  Google Scholar 

  24. 24.

    Osman Ö, Ayee Deniz O, Abdülkadir E, Cihat Ş, Hüsnü Oğuz S, Avse Banu Ç (2014) Cystatin C as biomarker of contrast-induced nephropathy in pediatric cardiac angiography. Turk J Med Sci 44:178–185

    Article  Google Scholar 

  25. 25.

    Hirsch R, Dent C, Pfriem H, Allen J, Beekman RH, Ma Q, Dastrala S, Bennett M, Mitsnefes M, Devarajan P (2007) NGAL is an early predictive biomarker of contrast-induced nephropathy in children. Pediatr Nephrol 22:2089–2095

    Article  Google Scholar 

  26. 26.

    Taylor ML, Carmona F, Thiagarajan RR, Westgate L, Ferguson MA, del Nido PJ, Rajagopal SK (2013) Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 146:146–152. https://doi.org/10.1016/j.jtcvs.2012.09.008

    Article  PubMed  Google Scholar 

  27. 27.

    Esch JJ, Salvin JM, Thiagarajan RR, Del Nido PJ, Rajagopal SK (2015) Acute kidney injury after Fontan completion: Risk factors and outcomes. J Thorac Cardiovasc Surg 150:190–197. https://doi.org/10.1016/j.jtcvs.2015.04.011

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (grant number: 81670375; JL, principal investigator)

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Correspondence to Xin Duan or Jinping Liu.

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Ethics approval for this single-center, retrospective cohort study was provided by Fuwai Hospital. The committee waived the need for informed consent for studies because of the retrospective study design.

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The authors declare no competing interests.

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Guo, S., Bai, L., Tong, Y. et al. Contrast media exposure in the perioperative period confers no additional risk of acute kidney injury in infants and young children undergoing cardiac surgery with cardiopulmonary bypass. Pediatr Nephrol (2021). https://doi.org/10.1007/s00467-021-04964-6

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Keywords

  • Acute kidney injury
  • Contrast media
  • Cardiac surgery
  • Cardiopulmonary bypass
  • Pediatrics