Abstract Objective To study whether hypoalbuminemia after pediatric cardiopulmonary bypass (CPB) for cardiac surgery is a risk factor for postoperative acute kidney injury (AKI). Methods A retrospective analysis was performed on the clinical data of 1 110 children who underwent CPB surgery between 2012 and 2016. According to the minimum serum albumin within 48 hours postoperatively, these patients were divided into hypoalbuminemia group (≤35 g/L) and normal albumin group (> 35 g/L). The two groups were compared in terms of perioperative data and the incidence of AKI. Furthermore, the incidence of AKI was compared again after propensity score matching for the unbalanced factors during the perioperative period. The perioperative risk factors for postoperative AKI were analyzed by logistic regression. Results The overall incidence rate of postoperative AKI was 13.78% (153/1 110), and the mortality rate was 2.52% (28/1 110). The mortality rate of children with AKI was 13.1% (20/153). The patients with hypoalbuminemia after surgery (≤35 g/L) accounted for 44.50% (494/1 110). Before and after propensity score matching, the hypoalbuminemia group had a significantly higher incidence of AKI than the normal albumin group (P < 0.05). The children with AKI had a significantly lower serum albumin level after surgery than those without AKI (P < 0.05). The multivariate logistic regression analysis showed albumin ≤35 g/L was one of the independent risk factors for postoperative AKI. Conclusions Albumin ≤35 g/L within 48 hours postoperatively is an independent risk factor for postoperative AKI in children after CPB surgery.
DUAN Lian,HU Guo-Huang,JIANG Meng et al. Association of hypoalbuminemia with acute kidney injury in children after cardiac surgery[J]. CJCP, 2018, 20(6): 475-480.
DUAN Lian,HU Guo-Huang,JIANG Meng et al. Association of hypoalbuminemia with acute kidney injury in children after cardiac surgery[J]. CJCP, 2018, 20(6): 475-480.
Toda Y, Sugimoto K. AKI after pediatric cardiac surgery for congenital heart diseases-recent developments in diagnostic criteria and early diagnosis by biomarkers[J]. J Intensive Care, 2017, 5:49.
[2]
Ruf B, Bonelli V, Balling G, et al. Intraoperative renal near-infrared spectroscopy indicates developing acute kidney injury in infants undergoing cardiac surgery with cardiopulmonary bypass:a case-control study[J]. Crit Care, 2015, 19:27.
[3]
de la Cruz KI, Bakaeen FG, Wang XL, et al. Hypoalbuminemia and long-term survival after coronary artery bypass:a propensity score analysis[J]. Ann Thorac Surg, 2011, 91(3):671-675.
[4]
Lee EH, Baek SH, Chin JH, et al. Preoperative hypoalbuminemia is a major risk factor for acute kidney injury following off-pump coronary artery bypass surgery[J]. Intensive Care Med, 2012, 38(9):1478-1486.
[5]
Taverna M, Marie AL, Mira JP, et al. Specific antioxidant properties of human serum albumin[J]. Ann Intensive Care, 2013, 3(1):4.
[6]
Xiao L, Ge Y, Sun L, et al. Cordycepin inhibits albumin-induced epithelial-mesenchymal transition of renal tubular epithelial cells by reducing reactive oxygen species production[J]. Free Radic Res, 2012, 46(2):174-183.
[7]
Peruchetti DB, Pinheiro AA, Landgraf SS, et al. (Na++K+)-ATPase is a target for phosphoinositide 3-kinase/protein kinase B and protein kinase C pathways triggered by albumin[J]. J Biol Chem, 2011, 286(52):45041-45047.
[8]
Curry S. Lessons from the crystallographic analysis of small molecule binding to human serum albumin[J]. Drug Metab Pharmacokinet, 2009, 24(4):342-357.
[9]
Becker BF, Chappell D, Bruegger D, et al. Therapeutic strategies targeting the endothelial glycocalyx:acute deficits, but great potential[J]. Cardiovasc Res, 2010, 87(2):300-310.
[10]
Moguel-González B, Wasung-de-Lay M, Tella-Vega P, et al. Acute kidney injury in cardiac surgery[J]. Rev Invest Clin, 2013, 65(6):467-475.
[11]
Kim WH, Park MH, Kim HJ, et al. Potentially modifiable risk factors for acute kidney injury after surgery on the thoracic aorta:a propensity score matched case-control study[J]. Medicine (Baltimore), 2015, 94(2):e273.
Lee EH, Kim WJ, Kim JY, et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0 g/dl[J]. Anesthesiology, 2016, 124(5):1001-1011.
[14]
Gulati S, Stephens D, Balfe JA, et al. Children with hypoalbuminemia on continuous peritoneal dialysis are at risk for technique failure[J]. Kidney Int, 2001, 59(6):2361-2367.
Jenkins KJ, Koch Kupiec J, Owens PL, et al. Development and validation of an agency for healthcare research and quality indicator for mortality after congenital heart surgery harmonized with risk adjustment for congenital heart surgery (RACHS-1) methodology[J]. J Am Heart Assoc, 2016, 5(5):e003028.
[17]
Gaies MG, Jeffries HE, Niebler RA, et al. Vasoactive-inotropic score is associated with outcome after infant cardiac surgery:an analysis from the Pediatric Cardiac Critical Care Consortium and Virtual PICU System Registries[J]. Pediatr Crit Care Med, 2014, 15(6):529-537.
[18]
Neff LP, Cannon JW, Morrison JJ, et al. Clearly defining pediatric massive transfusion:cutting through the fog and friction with combat data[J]. J Trauma Acute Care Surg, 2015, 78(1):22-28.
Jetton JG, Rhone ET, Harer MW, et al. Diagnosis and treatment of acute kidney injury in pediatrics[J]. Curr Treat Options Pediatr, 2016, 2:56-68.
[21]
Liu M, Chan CP, Yan BP, et al. Albumin levels predict survival in patients with heart failure and preserved ejection fraction[J]. Eur J Heart Fail, 2012, 14(1):39-44.
[22]
Wiedermann CJ, Wiedermann W, Joannidis M. Hypoalbuminemia and acute kidney injury:a meta-analysis of observational clinical studies[J]. Intensive Care Med, 2010, 36(10):1657-1665.
[23]
Wiedermann CJ, Wiedermann W, Joannidis M. Causal relationship between hypoalbuminemia and acute kidney injury[J]. World J Nephrol, 2017, 6(4):176-187.