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Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.

ABSTRACT: Acute kidney injury (AKI) after pediatric cardiac operations is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among children undergoing cardiac operations.This was a three-center, prospective study (2007-2009) of 277 children undergoing cardiac operations (n = 121, aged <2 years) with available preoperative BNP values. Preoperative BNP was measured and categorized into tertiles. The performance of BNP was evaluated alone and in combination with clinical factors. AKI was defined as doubling of serum creatinine or need for acute dialysis.Postoperative AKI occurred in 165 children (60%), with 118 cases (43%) being mild and 47 cases (17%) severe. Preoperative BNP was not associated with increased risk of mild or severe postoperative AKI and did not significantly improve AKI risk prediction when added to clinical models. Preoperative BNP was, however, associated with several clinical outcomes, including length of stay and mechanical ventilation. The results were similar when the analysis was repeated in the subset of children younger than 2 years of age or when the association of postoperative BNP and AKI was evaluated.Preoperative BNP levels did not predict postoperative AKI in this cohort of children undergoing cardiac operations. Both preoperative and postoperative BNP levels are associated with postoperative outcomes. Clinical Trial Registration at Clinicaltrials.gov as NCT00774137.

SUBMITTER: Hornik CP

PROVIDER: S-EPMC4041833 | biostudies-literature | 2014 Jun

REPOSITORIES: biostudies-literature

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Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.

Hornik Christoph P CP Krawczeski Catherine D CD Zappitelli Michael M Hong Kwangik K Thiessen-Philbrook Heather H Devarajan Prasad P Parikh Chirag R CR Patel Uptal D UD

The Annals of thoracic surgery 20140413 6

<h4>Background</h4>Acute kidney injury (AKI) after pediatric cardiac operations is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among children undergoing cardiac operations.<h4>Methods</h4>This was a three-center, prospective study (2007-2009) of 277 children undergoing cardiac operations (n = 121, aged <2 years) with available preoperative BNP values. ...[more]

PMID: 24725832

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Project description:Acute kidney injury (AKI) after cardiac surgery is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among patients undergoing cardiac surgery.The Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) study enrolled 1139 adults undergoing cardiac surgery at 6 hospitals from 2007 to 2009 who were selected for high AKI risk. Preoperative BNP was categorized into quintiles. AKI was common with the use of Acute Kidney Injury Network definitions; at least mild AKI was a ?0.3-mg/dL or 50% rise in creatinine (n=407, 36%), and severe AKI was either a doubling of creatinine or the requirement of acute renal replacement therapy (n=58, 5.1%). In analyses adjusted for preoperative characteristics, preoperative BNP was a strong and independent predictor of mild and severe AKI. Compared with the lowest BNP quintile, the highest quintile had significantly higher risk of at least mild AKI (risk ratio, 1.87; 95% confidence interval, 1.40-2.49) and severe AKI (risk ratio, 3.17; 95% confidence interval, 1.06-9.48). After adjustment for clinical predictors, the addition of BNP improved the area under the curve to predict at least mild AKI (0.67-0.69; P=0.02) and severe AKI (0.73-0.75; P=0.11). Compared with clinical parameters alone, BNP modestly improved risk prediction of AKI cases into lower and higher risk (continuous net reclassification index; at least mild AKI: risk ratio, 0.183; 95% confidence interval, 0.061-0.314; severe AKI: risk ratio, 0.231; 95% confidence interval, 0.067-0.506).Preoperative BNP level is associated with postoperative AKI in high-risk patients undergoing cardiac surgery. If confirmed in other types of patients and surgeries, preoperative BNP may be a valuable component of future efforts to improve preoperative risk stratification and discrimination among surgical candidates.

Project description:BackgroundAcute kidney injury (AKI) is a common complication of coronary artery bypass grafting (CABG) that results in worse prognosis. Studies have shown that recombinant human brain natriuretic peptide (rh-BNP) reduces renal injury. However, its treatment effects for AKI in patients underwent cardiac surgery are unclear. This study sought to explore the efficacy of rh-BNP in patients with AKI after bypass surgery.MethodsThis study included patients with AKI diagnosed within 4 days after CABG during the period January 2016 to December 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. The clinical characteristics and outcomes were collected. Patients were divided into BNP and non-BNP groups according to whether rh-BNP was injected intravenously after the operation. Multivariable logistic regression was adjusted the confounding effects between clinical characteristics and rh-BNP. Propensity score matching (PSM) was used to perform a sensitivity analysis.ResultsA total of 395 patients, including 56 and 339 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels (P<0.001) and postoperative urine volume (P=0.001) within 4 days of surgery were independent associated with rh-BNP. From PSM, 175 patients, including 44 and 131 patients in the BNP and non-BNP groups, respectively, were included in this study. The decreasing trend of postoperative serum creatinine levels in the BNP group was significantly stronger than that in the non-BNP group (0.04±0.28 vs. -0.16±0.36, P=0.001). The postoperative urine volume within 4 days of surgery of the BNP group was higher than that of the non-BNP group (11.3±2.8 vs. 9.11±2.66, P<0.001). The cumulative dosage of diuretics after the procedure did not differ between the BNP and non-BNP groups {60 [40, 80] vs. 60 [40, 120], P=0.852}.ConclusionsRh-BNP can reduce creatinine levels and increases postoperative urine volume to improve renal function in patients.

Project description:Acute kidney injury (AKI) after cardiac surgery is a common and serious complication. Although lower than normal serum bicarbonate levels are known to be associated with consecutive renal function deterioration in patients with chronic kidney injury, it is not well-known whether preoperative low serum bicarbonate levels are associated with the development of AKI in patients who undergo cardiac surgery. Therefore, the clinical implication of preoperative serum bicarbonate levels on AKI occurrence after cardiac surgery was investigated. Patients who underwent coronary artery bypass or valve surgery at Yonsei University Health System from January 2013 to December 2014 were enrolled. The patients were divided into 3 groups based on preoperative serum bicarbonate levels, which represented group 1 (below normal levels) <23?mEq/L; group 2 (normal levels) 23 to 24?mEq/L; and group 3 (elevated levels) >24?mEq/L. The primary outcome was the predicated incidence of AKI 48?hours after cardiac surgery. AKI was defined according to Acute Kidney Injury Network criteria. Among 875 patients, 228 (26.1%) developed AKI within 48?hours after cardiac surgery. The incidence of AKI was higher in group 1 (40.9%) than in group 2 (26.5%) and group 3 (19.5%) (P?<?0.001). In addition, the duration of postoperative stay in a hospital intensive care unit (ICU) was longer for AKI patients and for those in the low-preoperative-serum-bicarbonate-level groups. A multivariate logistic regression analysis showed that low preoperative serum bicarbonate levels were significantly associated with AKI even after adjustment for age, sex, hypertension, diabetes mellitus, operation type, preoperative hemoglobin, and estimated glomerular filtration rate. In conclusion, low serum bicarbonate levels were associated with higher incidence of AKI and prolonged ICU stay. Further studies are needed to clarify whether strict correction of bicarbonate levels close to normal limits may have a protective role in preventing further AKI development.

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Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.

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Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.

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