Cell-Free Plasma Hemoglobin and Male Gender Are Risk Factors for Acute Kidney Injury in Low Risk Children Undergoing Cardiopulmonary Bypass

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Abstract

Objectives:

To determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery.

Design:

Prospective observational study.

Setting:

Twelve-bed cardiac ICU in a university-affiliated children’s hospital.

Patients:

Children were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction.

Interventions:

None.

Measurements and Main Results:

Plasma and urine were collected at baseline (in a subset), the beginning and end of cardiopulmonary bypass, and 2 hours and 24 hours after cardiopulmonary bypass in 60 subjects. Levels of plasma hemoglobin increased during cardiopulmonary bypass and were associated (p < 0.01) with cardiopulmonary bypass duration (R2 = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R2 = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R2 = 0.27), and change in creatinine (R2 = 0.12). Forty-three percent of patients developed acute kidney injury. There was an association between plasma hemoglobin level and change in creatinine that varied by age (overall [R2 = 0.12; p < 0.01]; in age > 2 yr [R2 = 0.22; p < 0.01]; and in < 2 yr [R2 = 0.03; p = 0.42]). Change in plasma hemoglobin and male gender were found to be risk factors for acute kidney injury (odds ratio, 1.02 and 3.78, respectively; p < 0.05).

Conclusions:

Generation of plasma hemoglobin during cardiopulmonary bypass and male gender are associated with subsequent renal dysfunction in low-risk pediatric patients, especially in those older than 2 years. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing cardiopulmonary bypass would benefit from potential treatments for hemolysis and plasma hemoglobin–associated renal dysfunction.

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