Prevalence, associated factors and outcome of acute kidney injury among children and adolescents undergoing cardiopulmory bypass surgery in Nairobi, Kenya

Abstract

Background: Acute kidney injury is a serious complication associated with cardiopulmonary bypass surgery. According to the RIFLE system, patients are categorised as being at risk, having injury, and complete failure. The development of AKI is associated with substantial morbidity and mortality.

Objectives: To determine the prevalence, risk factors of AKI and outcome o-f children and adolescents with AKI following CPB surgery at KNH and Mater Hospital.

Study design: Prospective cohort study

Methods: 89 participants aged from birth to seventeen years were recruited consecutively. Creatinine measurements were obtained in the week before surgery, 8 hourly intervals in the first 24 hours post operatively, then at 48 hours. A ~25% decrease in creatinine clearance from baseline was used as the threshold to define AKI.

Results: The overall prevalence of AKI was 37.1%. According to the RIFLE system, Risk occurred in 34.8%, Injury in 11.2%, and Failure in 1.1 % of patients. Patients with AKI were older, median age 9 years (IQR 3-12), compared to 4 years OQR 1.5-8) for those without AKI. 55% of AKI patients had moderate to severe malnutrition compared to 34% of patients without AKI (OR 2.00, p=O.17). The median length of leu stay in AKI patients was 3days (lQR 2-4). The mortality rate in AKI Vs non AKI patients was 15.2% and 9% respectively (OR 1.8; 95% CI: 0.5-6.8, p=0.37). 18.2% of AKI patients required dialysis compared to 5% of non AKI patients (OR 3.9; 95% CI: 0.9-16.9, P=0.06).

Conclusions: The prevalence of AKI following CPB surgery in children and adolescents is associated with 2-fold odds of developing AKI. Recommendation; Malnourised cardiac patients need nutritional rehabilitation before undergoing bypass surgery cardiac operations should be performed at a younger age for the patients.