Hemodynamic Profile of Acute Kidney Injury Following the Fontan Procedure: Impact of Renal Perfusion Pressure.
BACKGROUND
Acute kidney injury (AKI) is common following cardiopulmonary bypass. Fontan completion may result in systemic venous hypertension and low cardiac output, reducing renal perfusion pressure (RPP) and further increasing the risk of AKI. We investigated the incidence and risk factors for post-Fontan AKI.


METHODS
Single-center retrospective study of children undergoing Fontan completion from 2005 to 2012. Demographic and hemodynamic variables were assessed for association with AKI. Subgroup analysis was performed on patients with high-grade AKI (creatinine increase of ≥2.0 × baseline). Vital sign data were collected hourly for the first postoperative day.


RESULTS
A total of 186 patients underwent Fontan at 3.1 (2.5-3.8) years of age and 13.5 kg (12.2-15.1). Acute kidney injury occurred in 97 (52%) patients, with high-grade AKI in 52 (28%). Univariate analysis identified reduced RPP in patients with AKI compared to those without AKI, 50 (45-56) mm Hg versus 58 (54-61) mm Hg ( P < .0001), due to lower mean arterial blood pressure, 63 (60-69) versus 70 (66-73) mm Hg ( P < .0001), and higher central venous pressure, 14 (12-16) versus 13 (11-14) mm Hg, ( p < .0001). Multivariable logistic regression and classification tree analyses further identified elements of RPP as significant predictors of AKI, especially high-grade AKI. Postoperative intubation was linked to AKI development. Patients with AKI had decreased postoperative urine output with increased colloid requirements, duration of chest tube insertion, and hospital length of stay.


CONCLUSION
Acute kidney injury occurs frequently following the Fontan procedure. Associated factors include reduced RPP, high colloid requirements, and postoperative intubation. Targeted hemodynamic interventions may serve to reduce the incidence of post-Fontan AKI.
['Patterson|Taylor|T|', 'Hehir|David A|DA|', 'Buelow|Matthew|M|', 'Simpson|Pippa M|PM|', 'Mitchell|Michael E|ME|', 'Zhang|Liyun|L|', 'Eslami|Mehdi|M|', 'Murkowski|Kathleen|K|', 'Scott|John P|JP|']
D058186:Acute Kidney Injury D002675:Child, Preschool D005260:Female D018729:Fontan Procedure D006330:Heart Defects, Congenital D006439:Hemodynamics D006801:Humans D015994:Incidence D007668:Kidney D008297:Male D011183:Postoperative Complications D012189:Retrospective Studies D012307:Risk Factors D015996:Survival Rate D014481:United States
acute kidney injury Fontan cardiopulmonary bypass single ventricle