ArticlePediatric nephrology (Berlin, Germany)2024
Persistent acute kidney injury and fluid accumulation with outcomes after the Norwood procedure: report from NEPHRON.
Article in Pediatric nephrology (Berlin, Germany), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 16 citations in OpenAlex.
- Growth after pediatric and neonatal acute kidney injury: a meta-analysis.Pediatric nephrology (Berlin, Germany) · 2025Pooled it
- Incidence of acute kidney injury-associated mortality in hospitalized children: a systematic review and meta-analysis.BMC nephrology · 2025Pooled it
- The incidence and risk factors associated with severe acute kidney injury and operative mortality in neonates following cardiac surgery: a single-center experience.Pediatric nephrology (Berlin, Germany) · 2026Article
- Modification of the Cardiac Renal Angina Index for Predicting Adverse Kidney Events After Pediatric Cardiac Surgery.Journal of the American Heart Association · 2025Observational
- Cardiac surgery-associated acute kidney injury in neonatal Norwood procedure: incidence, risk factors and impact on mortality and outcomes.Interdisciplinary cardiovascular and thoracic surgery · 2025Article
- C-C motif chemokine ligand 14 characterization for prediction of persistent severe AKI in post-cardiac surgery children.Pediatric nephrology (Berlin, Germany) · 2025Article
- Framework for Kidney Health Follow-Up Among Neonates With Critical Cardiac Disease: A Report From the Neonatal Kidney Health Consensus Workshop.Journal of the American Heart Association · 2025Review
- Cardiorenal syndrome: evolving concepts and pediatric knowledge gaps.Pediatric nephrology (Berlin, Germany) · 2025Review
- Biomarker-based acute kidney injury sub-phenotypes refine risk assessment in children undergoing cardiac surgery.Pediatric nephrology (Berlin, Germany) · 2025Observational
- Urine Output and Acute Kidney Injury in Neonates/Younger Children: A Prospective Study of Cardiac Surgery Patients with Indwelling Urinary Catheters.Clinical journal of the American Society of Nephrology : CJASN · 2024Article
- Kidney Health Monitoring in Neonatal Intensive Care Unit Graduates: A Modified Delphi Consensus Statement.JAMA network open · 2024Article
Corrections and comments
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Authors and funding
12 authors at 7 institutions in 1 country.
Funding
Abstract
backgroundCardiac surgery-associated acute kidney injury (CS-AKI) is common, but its impact on clinical outcomes is variable. Parsing AKI into sub-phenotype(s) and integrating pathologic positive cumulative fluid balance (CFB) may better inform prognosis. We sought to determine whether durational sub-phenotyping of CS-AKI with CFB strengthens association with outcomes among neonates undergoing the Norwood procedure.
methodsMulticenter, retrospective cohort study from the Neonatal and Pediatric Heart and Renal Outcomes Network. Transient CS-AKI: present only on post-operative day (POD) 1 and/or 2; persistent CS-AKI: continued after POD 2. CFB was evaluated per day and peak CFB during the first 7 postoperative days. Primary and secondary outcomes were mortality, respiratory support-free and hospital-free days (at 28, 60 days, respectively). The primary predictor was persistent CS-AKI, defined by modified neonatal Kidney Disease: Improving Global Outcomes criteria.
resultsCS-AKI occurred in 59% (205/347) neonates: 36.6% (127/347) transient and 22.5% (78/347) persistent; CFB > 10% occurred in 18.7% (65/347). Patients with either persistent CS-AKI or peak CFB > 10% had higher mortality. Combined persistent CS-AKI with peak CFB > 10% (n = 21) associated with increased mortality (aOR: 7.8, 95% CI: 1.4, 45.5; p = 0.02), decreased respiratory support-free (predicted mean 12 vs. 19; p < 0.001) and hospital-free days (17 vs. 29; p = 0.048) compared to those with neither.
conclusionsThe combination of persistent CS-AKI and peak CFB > 10% after the Norwood procedure is associated with mortality and hospital resource utilization. Prospective studies targeting intra- and postoperative CS-AKI risk factors and reducing CFB have the potential to improve outcomes.
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