Skip to main content
SpringerLink
Log in

Diuretic response after neonatal cardiac surgery: a report from the NEPHRON collaborative

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Multicenter early diuretic response (DR) analysis of single furosemide dosing following neonatal cardiac surgery is lacking to inform whether early DR predicts adverse clinical outcomes.

Methods

We performed a retrospective cohort study utilizing data from the NEPHRON registry. Random forest machine learning generated receiver operating characteristic-area under the curve (ROC-AUC) and odds ratios for mechanical ventilation (MV) and respiratory support (RS). Prolonged MV and RS were defined using ≥ 90th percentile of observed/expected ratios. Secondary outcomes were prolonged CICU and hospital length of stay (LOS) and kidney failure (stage III acute kidney injury (AKI), peritoneal dialysis, and/or continuous kidney replacement therapy on postoperative day three) assessed using covariate-adjusted ROC-AUC curves.

Results

A total of 782 children were included. Cumulative urine output (UOP) metrics were lower in prolonged MV and RS patients, but DR poorly predicted prolonged MV (highest AUC 0.611, OR 0.98, sensitivity 0.67, specificity 0.53, p = 0.006, 95% OR CI 0.96–0.99 for cumulative 6-h UOP) and RS (highest AUC 0.674, OR 0.94, sensitivity 0.75, specificity 0.54, p < 0.001, 95% CI 0.91–0.97 UOP between 3 and 6 h). Secondary outcome results were similar. DR had fair discrimination for kidney failure (AUC 0.703, OR 0.94, sensitivity 0.63, specificity 0.71, 95% OR CI 0.91–0.98, p < 0.001, cumulative 6-h UOP).

Conclusions

Early DR poorly discriminated patients with prolonged MV, RS, and LOS in this cohort, though it may identify severe postoperative AKI phenotype. Future work is warranted to determine if early DR or late postoperative DR later, in combination with other AKI metrics, may identify a higher-risk phenotype.

Graphical abstract

A higher resolution version of the Graphical abstract is available as Supplementary information

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data generated and analyzed during this study are available from PC4 and NEPHRON upon reasonable request.

References

  1. Aydin SISH, Blaufox AD, Parnell VA et al (2012) Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 94:1589–1595

    Article  PubMed  Google Scholar 

  2. Blinder JJ, Asaro LA, Wypij D et al (2017) Acute kidney injury after pediatric cardiac surgery: a secondary analysis of the safe pediatric euglycemia after cardiac surgery trial. Pediatr Crit Care Med 18:638–646

    Article  PubMed  PubMed Central  Google Scholar 

  3. Blinder JJ, Goldstein SL, Lee VV et al (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374

    Article  PubMed  Google Scholar 

  4. Toth R, Breuer T, Cserép Z et al (2012) Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 93:1984–1990

    Article  PubMed  Google Scholar 

  5. Jetton JG, Askenazi DJ (2012) Update on acute kidney injury in the neonate. Curr Opin Pediatr 24:191–196

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Kellum JA, Lameire N (2013) Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care 17:204

    Article  PubMed  PubMed Central  Google Scholar 

  7. Alten JA, Blinder JJ, Selewski DR et al (2021) Epidemiology of acute kidney injury after neonatal cardiac surgery: a report from the multicenter neonatal and pediatric heart and renal outcomes network. Crit Care Med 49:e941–e951

    Article  CAS  PubMed  Google Scholar 

  8. Bailly D, Alten JA, Gist KM et al (2022) Fluid accumulation after neonatal congenital cardiac operations. Clinical Implications and Outcomes. Ann Thorac Surg 114:2288–2294

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gist KM, Borasino S, SooHoo M et al (2021) Transient and persistent acute kidney injury phenotypes following the Norwood operation: a retrospective study. Cardiol Young 32:564–571

    Google Scholar 

  10. Gist KM, Fuhrman D, Stanski N, Menon S, Soranno DE (2022) Subphenotypes of acute kidney injury in children. Curr Opin Crit Care 286:590–598

    Article  Google Scholar 

  11. Goldstein SL, Akcan-Arikan A, Alobaidi R et al (2022) Consensus-based recommendations on priority activities to address acute kidney injury in children: a modified Delphi statement. JAMA Netw Open 5:e2229442

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kakajiwala A, Young Kim J, Hughes JZ et al (2017) Lack of furosemide responsiveness predicts acute kidney injury in infants after cardiac surgery. Ann Thorac Surg 104:1388–1394

    Article  PubMed  Google Scholar 

  13. Borasino S, Wall KM, Crawford JH et al (2018) Furosemide response predicts acute kidney injury after cardiac surgery in infants and neonates. Pediatr Crit Care Med 19:310–317

    Article  PubMed  Google Scholar 

  14. Penk J, Gist KM, Wald EL et al (2019) Furosemide response predicts acute kidney injury in children after cardiac surgery. J Thorac Cardiovasc Surg 157:2444–2451

    Article  CAS  PubMed  Google Scholar 

  15. Price JF, Younan S, Cabrera AG et al (2019) Diuretic responsiveness and its prognostic significant in children with heart failure. J Card Fail 25:941–947

    Article  PubMed  Google Scholar 

  16. Gist KM, Blinder JJ, Bailly D et al (2019) Neonatal and paediatric heart and renal outcomes network: design of a multi-centre retrospective cohort study. Cardiol Young 29:511–518

    Article  PubMed  Google Scholar 

  17. Gaies M, Cooper DS, Tabbutt S et al (2015) Collaborative quality improvement in the cardiac intensive care unit: development of the Paediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 25:951–957

    Article  PubMed  Google Scholar 

  18. Gaies M, Donohue JE, Willis GM et al (2016) Data integrity of the Pediatric Cardiac Critical Care Consortium (PC4) clinical registry. Cardiol Young 26:1090–1096

    Article  PubMed  Google Scholar 

  19. Schuette J, Zaccagni H, Donohue J et al (2022) Assessing data accuracy in a large multi-institutional quality improvement registry: an update from the Pediatric Cardiac Critical Care Consortium (PC4). Cardiol Young 32:1742–1747

    Article  PubMed  Google Scholar 

  20. LoBasso M, Schneider J, Sanchez-Pinto LN et al (2022) Acute kidney injury and kidney recovery after cardiopulmonary bypass in children. Pediatr Nephrol 37:659–665

    Article  PubMed  Google Scholar 

  21. Ruth A, Basu RK, Gillespie S et al (2021) Early and late acute kidney injury: temporal profile in the critically ill patient. Clin Kidney J 15:311–319

    Article  PubMed  PubMed Central  Google Scholar 

  22. Gist KM, SooHoo M, Mack E et al (2022) Modifying the Renal Angina Index for predicting AKI and related adverse outcomes in pediatric cardiac surgery. World J Pediatr Congenit Heart Surg 13:196–202

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We recognize Castin’ ‘N Catchin’ Charity Organization via Children’s of Alabama that helped fund NEPHRON and Cincinnati Children’s Hospital Medical Center Heart Institute Research Core that provided statistical support and oversight.

Funding

Funding for NEPHRON was provided through Castin’ ‘N Catchin’ Charity Organization.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Palo Alto, CA, 94304, USA

    Joshua J. Blinder & David M. Kwiatkowski

  2. Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA

    Jeffrey Alten & Katja M. Gist

  3. Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, UT, USA

    David Bailly

  4. Division of Cardiology, Department of Pediatrics, Medical University of South Carolina Children’s Hospital, Charleston, SC, USA

    Jason Buckley

  5. Division of Cardiology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Shanelle Clarke

  6. Division of Cardiac Critical Care Medicine, Department of Anesthesia/Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    J. Wesley Diddle

  7. Division of Pediatric Cardiology, Department of Pediatrics, Arkansas Children’s Hospital, Little Rock, AK, USA

    Xiomara Garcia

  8. Division of Critical Care, Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Joshua Koch

  9. Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    A. K. M. Fazlur Rahman

  10. Division of Pediatric Cardiology, Department of Pediatrics, C. S. Mott Children’s Hospital and University of Michigan Medical School, Ann Arbor, MI, USA

    Garrett Reichle

  11. Division of Pediatric Critical Care, Department of Pediatrics, Riley Children’s Hospital, Indiana University, Indianapolis, IN, USA

    Kevin Valentine

  12. Section of Pediatric Cardiac Critical Care, Division of Cardiology, Department of Pediatrics, University of Alabama, Birmingham, Birmingham, AL, USA

    Kristal M. Hock & Santiago Borasino

Authors
  1. Joshua J. Blinder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey Alten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Bailly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jason Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shanelle Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Wesley Diddle
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiomara Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katja M. Gist
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Joshua Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. David M. Kwiatkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. K. M. Fazlur Rahman
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Garrett Reichle
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kevin Valentine
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kristal M. Hock
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Santiago Borasino
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

NEPHRON Collaborators

Corresponding author

Correspondence to Joshua J. Blinder.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Graphical abstract (PPTX 190 KB)

Supplementary file2 (DOCX 371 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blinder, J.J., Alten, J., Bailly, D. et al. Diuretic response after neonatal cardiac surgery: a report from the NEPHRON collaborative. Pediatr Nephrol (2024). https://doi.org/10.1007/s00467-024-06380-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00467-024-06380-y

Keywords

Search

Navigation