Konjenital Kalp Hastalıkları Ameliyatlarından Sonra Gelişen Akut Böbrek Hasarına Etki Eden Faktörlerin İncelenmesi

Abstract

DERELİ, M. A. Factors Affecting Acute Kidney Injury After Surgery for Congenital Heart Disease. Hacettepe University Faculty of Medicine, Department of Child Health and Diseases, Medical Specialty Thesis, Ankara, 2026. Acute kidney injury (AKI) is a frequent complication after surgery for congenital heart disease (CHD) and is associated with adverse outcomes. This study aimed to determine the incidence of postoperative AKI, identify factors associated with its development, and evaluate its relationship with morbidity and mortality in children undergoing CHD surgery. This retrospective single-center study included 219 patients aged 18 years or younger who underwent surgery for CHD between January 1, 2023, and December 31, 2024. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 criteria. Demographic, clinical, intraoperative, postoperative, and laboratory variables were analyzed, and logistic regression analyses were performed to examine factors associated with AKI. Postoperative AKI developed in 71 patients (32.4%) and occurred predominantly on postoperative day 0 (mean 0.45±1.13 days). In univariable analyses, AKI was associated with lower weight-for-age and height-for-age z-scores, history of cardiopulmonary arrest, preoperative invasive mechanical ventilation, cyanosis and single-ventricle physiology, lower preoperative blood urea nitrogen, albumin, sodium, and creatinine levels, higher RACHS-1 and STAT categories, higher STAT score, longer aortic clamp and cardiopulmonary bypass times, higher postoperative vasoactive inotropic scores, greater postoperative day 0 fluid overload, unfavorable early postoperative laboratory changes, and exposure to aminoglycosides and vancomycin. In the final multivariable logistic regression model, age at the time of surgery, percentage change in blood urea nitrogen, and percentage change in sodium remained statistically significant; each 1-month increase in age at surgery was associated with an approximately 0.8% decrease in the odds of postoperative acute kidney injury (OR: 0.992, 95% CI: 0.984-0.999; p=0.028), whereas each 1-unit increase in blood urea nitrogen percentage change and sodium percentage change was associated with approximately 1.3% (OR: 1.013, 95% CI: 1.007-1.020; p<0.001) and 12.9% (OR: 1.129, 95% CI: 1.035-1.231; p=0.006) higher odds of AKI, respectively. Because percentage changes in BUN and sodium were derived from postoperative day 0 values, these variables were interpreted as early postoperative biochemical indicators rather than causal predictors. Patients with AKI had significantly higher rates of extracorporeal membrane oxygenation (22.5% vs 1.4%) and mortality (21.1% vs 0.7%), as well as longer intubation, mechanical ventilation, intensive care unit stay, and hospital stay (all p<0.001). AKI occurred in nearly one-third of children after CHD surgery and usually developed within the first 24 postoperative hours. Preoperative clinical vulnerability, higher surgical complexity, perioperative hemodynamic burden, fluid accumulation, and nephrotoxic exposure were all associated with AKI development. Early recognition of high-risk patients and careful perioperative management may help reduce AKI-related morbidity and mortality.