perinatologyРоссийский вестник перинатологии и педиатрииRossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics)1027-40652500-2228Ltd. “The National Academy of Pediatric Science and Innovation”10.21508/1027-4065-2019-64-2-63-67perinatology-858Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESФакторы риска кардиохирургически-ассоциированного острого повреждения почек у новорожденных и грудных детей с врожденными пороками сердцаRisk factors of acute cardiac surgery-associated kidney injury in newborns and infants with congenital heart defectshttps://orcid.org/0000-0003-2992-2255СеливерстоваА. А.SeliverstovaA. A.

Селиверстова Анастасия Алексеевна – аспирант кафедры факультетской педиатрии, врач-кардиолог отделения анестезиологии и реанимации детей с кардиохирургической патологией клиники.

194100 Санкт-Петербург, ул. Литовская, д. 2.

Saint-Petersburg

alisa-0072006@yandex.ruhttps://orcid.org/0000-0002-9415-4785СавенковаН. Д.SavenkovaN. D.

Савенкова Надежда Дмитриевна – д.м.н., проф., зав. кафедрой факультетской педиатрии.

194100 Санкт-Петербург, ул. Литовская, д. 2.

Saint-Petersburg

МарченкоС. П.MarchenkoS. P.

Марченко Сергей Павлович – д.м.н., проф. кафедры сердечно-сосудистой хирургии.

194100 Санкт-Петербург, ул. Литовская, д. 2.

Saint-Petersburg

ФГБОУ ВО «Санкт-Петербургский государственный педиатрический медицинский университет» Минздрава РоссииРоссияSaint-Petersburg State Pediatric Medical UniversityRussian Federation2019140520196426367Copyright © Ltd. “The National Academy of Pediatric Science and Innovation”, 20192019Ltd. “The National Academy of Pediatric Science and Innovation”Ltd. “The National Academy of Pediatric Science and Innovation”https://www.ped-perinatology.ru/jour/about/submissions#copyrightNoticehttps://www.ped-perinatology.ru/jour/article/view/858

Цель исследования. Выявить факторы риска кардиохирургически-ассоциированного острого повреждения почек у 214 новорожденных и детей грудного возраста с врожденными пороками сердца. Результаты. Частота кардиохирургически-ассоциированного острого повреждения почек у 95 новорожденных составила 54,7%, у 119 детей грудного возраста – 46,2%. Установлены статистически значимые факторы риска кардиохирургически-ассоциированного острого повреждения почек: у новорожденных – уровень лактата в плазме крови более 2,5 ммоль/л и проведение искусственной вентиляции легких (87,1% по сравнению с 39,1% без таких факторов; 93,8 и 46,8% соответственно; р<0,001), у грудных детей – уровень лактата в плазме крови более 2,5 ммоль/л перед оперативным вмешательством таковыми, не имеющими этого фактора (96,4% по сравнению с 30,8% без этого фактора; р<0,001).

Objective. To identify risk factors for acute cardiac surgery-associated kidney damage in 214 newborns and infants with congenital heart defects. Results. 54.7% of 95 newborns and 46.2% of 119 infants have acute cardiac surgery-associated kidney injury. There have been determined statistically significant risk factors of acute cardiac surgery-associated kidney injury: in newborns – the level of lactate in blood plasma more than 2.5 mmol/l and artificial lung ventilation (87.1% as compared to 39.1% without these factors; 93.8 and 46.8% accordingly; р<0.001), in infants – level of lactate in blood plasma more than 2.5 mmol/l before surgery as compared to those without these factors (96.4% as compared to 30.8% without this factor; р<0.001).

новорожденныедети грудного возрастакардиохирургически-ассоциированное острое повреждение почекфакторы рискалактат в кровиискусственная вентиляция легкихnewbornsinfantsacute cardiac surgery-associated kidney damagerisk factorslactate in the bloodartificial lung ventilationReferencesKlauwer D., Neuhäuser C., Thul J., Zimmermann R. Pädiatrische Intensivmedizin – Kinderkardiologische Praxis. Copyright by Deutscher Ärzte-Verlag GmbH 2013; 93–125Klauwer D., Neuhäuser C., Thul J., Zimmermann R. Pädiatrische Intensivmedizin – Kinderkardiologische Praxis. Copyright by Deutscher Ärzte-Verlag GmbH 2013; 93–125Li S., Krawczeski C.D., Zappitelli M., Devarajan P., ThiessenPhilbrook H., Coca S.G. et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery – a prospective multicenter study. Crit Care Med 2011; 39(6): 1493–1499. DOI: 10.1097/CCM.0b013e31821201d3Li S., Krawczeski C.D., Zappitelli M., Devarajan P., ThiessenPhilbrook H., Coca S.G. et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery – a prospective multicenter study. Crit Care Med 2011; 39(6): 1493–1499. DOI: 10.1097/CCM.0b013e31821201d3Blinder J.J., Goldstein S.L., Lee V.V., Baycroft A., Fraser C.D., Nelson D., Jefferies J.L. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012; 143: 368–374. DOI: 10.1016/j.jtcvs.2011.06.021Blinder J.J., Goldstein S.L., Lee V.V., Baycroft A., Fraser C.D., Nelson D., Jefferies J.L. Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 2012; 143: 368–374. DOI: 10.1016/j.jtcvs.2011.06.021Toth R., Breuer T., Cserep Z., Lex D., Fazekas L., Sapi E., et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012; 93: 1984–1990. DOI: 10.1016/j.athoracsur.2011.10.046Toth R., Breuer T., Cserep Z., Lex D., Fazekas L., Sapi E., et al. Acute kidney injury is associated with higher morbidity and resource utilization in pediatric patients undergoing heart surgery. Ann Thorac Surg 2012; 93: 1984–1990. DOI: 10.1016/j.athoracsur.2011.10.046Aydin S.I., Seiden H.S., Blaufox A.D., Parnell V.A., Choudhury T., Punnoose A., Schneider J. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012; 94: 1589–1595. DOI: 10.1016/j.athoracsur.2012.06.050Aydin S.I., Seiden H.S., Blaufox A.D., Parnell V.A., Choudhury T., Punnoose A., Schneider J. Acute kidney injury after surgery for congenital heart disease. Ann Thorac Surg 2012; 94: 1589–1595. DOI: 10.1016/j.athoracsur.2012.06.050Morgan C.J., Zappitelli M., Robertson C.M., Alton G.Y., Sauve R.S., et al. Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2012; 162(1): 120–127.e1. DOI: 10.1016/j.jpeds.2012.06.054Morgan C.J., Zappitelli M., Robertson C.M., Alton G.Y., Sauve R.S., et al. Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr 2012; 162(1): 120–127.e1. DOI: 10.1016/j.jpeds.2012.06.054Taylor M.L., Carmona F., Thiagarajan R.R., Westgate L., Ferguson M.A., et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2013; 146(1): 146–152. DOI: 10.1016/j.jtcvs.2012.09.008Taylor M.L., Carmona F., Thiagarajan R.R., Westgate L., Ferguson M.A., et al. Mild postoperative acute kidney injury and outcomes after surgery for congenital heart disease. J Thorac Cardiovasc Surg 2013; 146(1): 146–152. DOI: 10.1016/j.jtcvs.2012.09.008Alabbas A., Campbell A., Skippen P., Human D., Matsell D., Mammen C. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 2013; 28(7): 1127–1134. DOI: 10.1007/s00467-0132454-3Alabbas A., Campbell A., Skippen P., Human D., Matsell D., Mammen C. Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol 2013; 28(7): 1127–1134. DOI: 10.1007/s00467-0132454-3Ricci Z., Di Nardo M., Iacoella C., Netto R., Picca S., Cogo P. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 2013; 34(6): 1404–1408. DOI: 10.1007/s00246-013-0662-zRicci Z., Di Nardo M., Iacoella C., Netto R., Picca S., Cogo P. Pediatric RIFLE for acute kidney injury diagnosis and prognosis for children undergoing cardiac surgery: a single-center prospective observational study. Pediatr Cardiol 2013; 34(6): 1404–1408. DOI: 10.1007/s00246-013-0662-zGil-Ruiz Gil-Esparza M.A., Alcaraz Romero A.J., Romero Otero A. Gil Villanueva N., Sanavia Morán E., Rodríguez Sánchez de la Blanca A. et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014; 29(7): 1265–1272. DOI: 10.1007/s00467-014-2757-zGil-Ruiz Gil-Esparza M.A., Alcaraz Romero A.J., Romero Otero A. Gil Villanueva N., Sanavia Morán E., Rodríguez Sánchez de la Blanca A. et al. Prognostic relevance of early AKI according to pRIFLE criteria in children undergoing cardiac surgery. Pediatr Nephrol 2014; 29(7): 1265–1272. DOI: 10.1007/s00467-014-2757-zPiggott K.D., Soni M., Decampli W.M., Ramirez J.A., Holbein D., Fakioglu H., Blanco C.J., Pourmoghadam K.K. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2015; 6(3): 401–406. DOI: 10.1177/2150135115586814Piggott K.D., Soni M., Decampli W.M., Ramirez J.A., Holbein D., Fakioglu H., Blanco C.J., Pourmoghadam K.K. Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2015; 6(3): 401–406. DOI: 10.1177/2150135115586814Greenberg J.H., Zappitelli M., Devarajan P., Thiessen-Philbrook H.R., Krawczeski C., Li S. et al. Kidney outcomes 5 years after pediatric cardiac surgery: The TRIBE-AKI Study JAMA Pediatr 2016; 170(11): 1071–1078. DOI: 10.1001/jamapediatrics.2016.1532.80Greenberg J.H., Zappitelli M., Devarajan P., Thiessen-Philbrook H.R., Krawczeski C., Li S. et al. Kidney outcomes 5 years after pediatric cardiac surgery: The TRIBE-AKI Study JAMA Pediatr 2016; 170(11): 1071–1078. DOI: 10.1001/jamapediatrics.2016.1532.80Селиверстова А.А., Савенкова Н.Д., Хубулава Г.Г., Марченко С.П., Наумов А.Б. Острое повреждение почек у новорожденных и детей грудного возраста с врожденными пороками сердца после кардиохирургических вмешательств. Нефрология 2017; 21(3): 54–60. DOI: 10.24884/1561-6274-2017-3-54-60.Seliverstova A.A., Savenkova N.D., Hubulava G.G., Marchenko S.P., Naumov A.B. Acute kidney injury rate in neonates and infants after cardiac surgery. Nefrologiya (Nefrologia) 2017; 21(3): 54–60. DOI: 10.24884/1561-6274-2017-3-54-60 (in Russ)Селиверстова А.А., Савенкова Н.Д., Марченко С.П., Наумов А.Б. Кардиохирургически-ассоциированное острое повреждение почек у детей. Нефрология 2016; 20(3): 17–27Seliverstova A.A., Savenkova N.D., Marchenko S.P., Naumov A.B. Cardiac surgery-associated acute kidney injury in children. Nefrologiya (Nefrologia) 2016; 20 (3); 17–27 (in Russ)Бокерия Л.А., Туманян М.Ф., Филаретова О.В., Андерсон А.Г., Трунина И.И., Харькин А.В. Нехирургические факторы риска неблагоприятного исхода кардиохирургических вмешательств в неонатальном периоде. Российский вестник перинатологии и педиатрии 2011; 56(6): 19–25.Bockeria L.A., Tumanyan O.V., Filaretova O.V., Аnderson А.G., Trunina I.I., Khar’kin А.V. Non-surgical risk factors of cardiosurgical interventions. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 2011; 56(6): 19–25. (in Russ)Seliverstova A.A., Savenkova N.D., Marchenko S.P. Cardiac surgery-associated acute kidney injury. Pediatr Nephrol 2017; 32(9): 1689Seliverstova A.A., Savenkova N.D., Marchenko S.P. Cardiac surgery-associated acute kidney injury. Pediatr Nephrol 2017; 32(9): 1689Jenkins K.J., Gauvreau K., Newburger J.W., Spray T., Moller J.H., Iezzoni L.I. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123(1): 110–118.Jenkins K.J., Gauvreau K., Newburger J.W., Spray T., Moller J.H., Iezzoni L.I. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123(1): 110–118.Jenkins K.J., Gauvreau K. Center-specific differences in mortality: preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124(1): 97–104.Jenkins K.J., Gauvreau K. Center-specific differences in mortality: preliminary analyses using the risk adjustment in congenital heart surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124(1): 97–104.Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G., Levin A. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31. DOI: 10.1186/cc5713Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G., Levin A. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11(2): R31. DOI: 10.1186/cc5713

The authors declare that there are no conflicts of interest present.