Background
Diuretics are used to manage
congestive heart failure in infants with
congenital heart disease. Adult data indicate that preoperative
diuretic use increases the risk of cardiac surgery associated
acute kidney injury (CS-AKI). We have sought to understand if preoperative
diuretics in infants increases the risk of CS-AKI. Methods and Results This is a single-center retrospective study of infants (1-12 months) who had CS requiring
cardiopulmonary bypass between 2013 and 2018. The diagnosis and severity of CS-AKI was defined according to the
Kidney Disease Improving Global Outcomes guidelines. Three hundred patients were included (mean 6 months, SD 2.4, range 1.2-12.9 months). A total of 149 (49.7%) patients were diagnosed with CS-AKI (stage 1: 80 [54%], stage 2: 57 [38%], stage 3: 12 [8%]). Logistic regression analysis showed preoperative
diuretics were not associated with CS-AKI (odds ratio [OR], 0.79; 95% CI, 0.43-1.44; P=0.45). A diagnosis of
tetralogy of Fallot was an independent risk factor for CS-AKI (OR, 3.49; 95% CI, 1.33-9.1, P=0.01). A diagnosis of
tetralogy of Fallot (OR, 3.6; 95% CI, 1.28-10.22; P=0.02) and longer
cardiopulmonary bypass (OR, 1.01; 95% CI, 1.0-1.02; P=0.04) time are risk factors for moderate to severe CS-AKI. Conclusions Preoperative
diuretic use does not contribute to the risk of CS-AKI in infants early after surgery. A diagnosis of
tetralogy of Fallot was the only risk factor for CS-AKI identified using multivariate analysis in our cohort. Furthermore, a diagnosis of
tetralogy of Fallot and longer
cardiopulmonary bypass time are risk factors for moderate to severe CS-AKI.