Abstract
Objective. Identify the frequency and the risk factors for the acute kidney injury (AKI) after surgery for the pathology of the aortic
arch in neonates.
Material and methods. A retrospective comparative study included 137 newborns, underwent aortic arch repair from January 2009
to December 2017. Patients were divided into two groups: the first group consisted of 105 patients without AKI after the operation
and 32 patients with AKI were assigned to the second group. In the general study group (n=137), the incidence of AKI was 23.3%.
AKI I was observed in 17 (12.4%) patients, AKI II in 10 (7.3%), AKI III in 5 (3.6%) patients. Renal replacement therapy (RRT) was
required in 9 (6.5%) cases.
Results. Hospital mortality was higher in patients with AKI: 5.7% in the first group, 12.5% in the second (p=0.028). Prematurity
increases the risk of developing an AKI of 1.84 (OR) 1.84, 95% CI 1.09–3.17, p=0.003). Infusion of prostaglandins reduces the
risk of AKI by 2.6 times (OR 1.39, 95% CI 0.21–0.78, p=0.005). Cardiopulmonary bypass (CPB) duration greater than 120 minutes
increases the chance of development of AK by 18% (OR 1.18, 95% CI 1.02–1.88, p=0.024), and circulatory arrest is
1.7 times (OR 1.71, 95% CI 1.07–2.19, p=0.017). Hyperlactatemia greater than 5 mmol / L at the first 24 hours after surgery
increases the chance of an AKI occurrence by 51% (OR 1.51, 95% CI 1.12–2.36, p=0.011). Combined operations also increase
the risk of OPP: resection of aortic coarctation with an ventricular septal defect (VSD) plastic by 1.16 times (OR 1.16, 95% CI
1.03–1.45, p=0.028), and of the aortic arch reconstruction with the plastic of the VSD – by 2.26 times (OR 2.26, 95% CI
1.38–3.11, p=0.006).
Conclusion. The risk factors for the development of AKI after surgery for the pathology of the aortic arch in neonates: prematurity,
absence of prostaglandin infusion before surgery, CPB duration greater than 120 minutes, circulatory arrest, combined operations:
resection of aortic coarctation with an VSD plastic and aortic arch reconstruction with plastic VSD, lactate acidosis more than
5 mmol/l in the first day after the operation.
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About the authors
- Saveliy E. Shcheglov, Anestesiologist-Intensivist, orcid.org/0000-0002-1126-0022;
-
Klara T. Shcheglova, Anestesiologist-Intensivist, orcid.org/0000-0001-8468-4806;
-
Aleksandr A. Gornostaev, Anestesiologist-Intensivist, Head of Departament, orcid.org/0000-0002-4477-0037;
-
Aleksey E. Chernogrivov, Dr Med. Sc., Head of Department, orcid.org/0000-0002-6207-4799;
-
Vladlen V. Bazylev, Dr Med. Sc., Chief Physicion, orcid.org/0000-0001-6089-9722
