G360\u2005Acute kidney injury and short-term renal support in the post-operative management of neonates following repair of transposition of the great arteries

Abstract

Aims Neonates requiring congenital cardiac surgery are at risk of acute kidney injury associated with significant morbidity, mortality, and increased hospital length of stay; treatment may require renal replacement therapy. Data for single cardiac defect cohorts is important to stratify risk, but is lacking for transposition of the great arteries. Our study aimed at collecting data for this single lesion. Methods A single-centre, retrospective analysis of 71 cases of arterial switch operation in neonates with isolated transposition of the great arteries, or transposition of the great arteries with ventricular septal defect, presenting between 2005–2015. Analysis included assessment of length of stay, renal function and need for renal replacement therapy. Results Acute kidney injury developed in 50.7%, and was associated with longer paediatric intensive care (p=0.002) and hospital stays (p=0.024). Paediatric intensive care unit length of stay correlated with higher peak creatinine and urea (p<0.05) and also with higher lactate levels at paediatric intensive care unit admission and 1 and 6\u2009hours post-admission (p<0.05). Renal replacement therapy via peritoneal dialysis was delivered to 11.1%, however this did not prolong paediatric intensive care unit length of stay. Initiation of renal replacement therapy was associated with a positive fluid balance at 1 (p=0.011) and 6\u2009hours (p=0.015). Conclusions This study analyses renal outcomes in a cohort of neonates with transposition of the great arteries undergoing an arterial switch operation. Acute kidney injury is a significant complication, with accompanying need for renal replacement therapy. Development of acute kidney injury, and a positive fluid balance, were both associated with increased length of stay. Initiation of renal replacement therapy was not associated with increased length of stay, and with some evidence from the literature that early or prophylactic peritoneal dialysis improves outcomes, these data report minimal complication rates which may be important as part of the decision matrix to utilise peritoneal dialysis in management of fluid balance post-operatively.