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- Title
First-stage palliation strategy for univentricular heart disease may impact risk for acute kidney injury.
- Authors
Goldstein, Bryan H.; Goldstein, Stuart L.; Devarajan, Prasad; Zafar, Farhan; Kwiatkowski, David M.; Marino, Bradley S.; Morales, David L. S.; Krawczeski, Catherine D.; Cooper, David S.
- Abstract
<bold>Objective: </bold>Norwood palliation for patients with single ventricle heart disease is associated with a significant risk for acute kidney injury, which portends a worse prognosis. We sought to investigate the impact of hybrid stage I palliation (Hybrid) on acute kidney injury risk.<bold>Design: </bold>This study is a single-centre prospective case-control study of seven consecutive neonates with single ventricle undergoing Hybrid palliation. Levels of serum creatinine and four novel urinary biomarkers, namely neutrophil gelatinase-associated lipocalin, interleukin-18, liver fatty acid-binding protein, and kidney injury molecule-1, were obtained before and after palliation. Acute kidney injury was defined as a ⩾50% increase in serum creatinine within 48 hours after the procedure. Data were compared with a contemporary cohort of 12 neonates with single ventricle who underwent Norwood palliation.<bold>Results: </bold>Patients who underwent Hybrid were more likely to be high-risk candidates (86 versus 25%, p=0.01) compared with those who underwent Norwood. Despite similar preoperative serum creatinine levels, there was a trend towards higher levels of postoperative peak serum creatinine (0.7 [0.63, 0.94] versus 0.56 [0.47, 0.74], p=0.06) and rate of acute kidney injury (67 versus 29%, p=0.17) in the Norwood cohort. Preoperative neutrophil gelatinase-associated lipocalin (58.4 [11, 86.3] versus 6.3 [5, 16.2], p=0.07) and interleukin-18 (30.6 [9.6, 167.2] versus 6.3 [6.3, 16.4], p=0.03) levels were higher in the Hybrid cohort. Nevertheless, longitudinal mixed-effect models demonstrated Hybrid palliation to be a protective factor against increased postoperative levels of neutrophil gelatinase-associated lipocalin (estimate -1.8 [-3.0, -9.0], p<0.001) and liver fatty acid-binding protein (-49.3 [-89.7, -8.8], p=0.018).<bold>Conclusions: </bold>In this single-centre case-control study, postoperative acute kidney injury risk did not differ significantly by single ventricle stage I treatment strategy; however, postoperative elevation in novel urinary biomarkers, consistent with subclinical kidney injury, was encountered in the Norwood cohort but not in the Hybrid cohort.
- Subjects
PALLIATIVE treatment; HEART diseases; ACUTE kidney failure; BIOMARKERS; BLOOD serum analysis; DISEASE risk factors; HEART ventricle abnormalities; CARRIER proteins; CREATININE; CARDIAC surgery; HEART ventricles; INTERLEUKINS; KIDNEY function tests; LONGITUDINAL method; RESEARCH funding; CASE-control method; HYPOPLASTIC left heart syndrome; DIAGNOSIS
- Publication
Cardiology in the Young, 2018, Vol 28, Issue 1, p93
- ISSN
1047-9511
- Publication type
journal article
- DOI
10.1017/S1047951117001640