Acute kidney injury in children hospitalized with unoperated structural congenital heart disease

Abstract

Abstract Background Most acute kidney injury (AKI ) has been reported in post operative children with congenital heart disease (CHD); limited data is available on unoperated cases who get admitted frequently with recurrent heart failure and pneumonia. Methods This observational study enrolled 125 (77M, 48F) hospitalized children (100 retrospective during 2019–2020 and 25 prospective in 2021) with unoperated structural CHD (2 months-5 years) with a minimum stay of 7 days. The primary objective was to determine proportion of children developing AKI by KDIGO and pRIFLE definition, during hospital stay; secondary objectives were to identify the risk factors for AKI. Children with underlying structural kidney diseases were excluded. Baseline serum creatinine values were obtained at admission followed by D3, D7 and weekly thereafter until discharge/death during the course of hospitalization. Results The median (IQR) age of enrolment was 6 (4–11) months; 72.8% had acyanotic and 27.2% cyanotic CHD. AKI as defined by KDIGO was seen in 50.4% and by pRIFLE in 56%; 27.2%, 12.8% % and 10.4% had stage I, II and stage III AKI by KDIGO classification. Timing of onset of AKI for most children (58.7%) was at admission (day 1). The mean recovery time from AKI was 11.2 days. Presence of hypovolemia (p = 0.015), cyanotic spells (p = 0.029), sepsis (p = 0.021), longer duration of ACE inhibitors (p = 0.029) and diuretic intake (p = 0.031) were significantly associated with AKI. Conclusion Significant proportion of children with unoperated CHD develop AKI during hospitalization which may have consequences on their post operative outcomes and progression to chronic kidney disease.