Elevated central venous-intrabdominal pressure associated with higher incidence of acute kidney injury following cardiac surgery in pediatric patients: a prospective observational study.

OBJECTIVE

The occurrence and development of acute kidney injury (AKI) is closely related to renal hemodynamic dysfunction. The sum of central venous pressure (CVP) and intra-abdominal pressure (IAP) which named Central venous-intrabdominal pressure (CIP) in exploring the relationship with postoperative AKI in pediatric cardiac surgery has received limited exploration yet. Our study sought to investigate the association between CIP and AKI following pediatric cardiac surgery.

METHODS

This single-center prospective observational study included pediatric patients who underwent open-heart surgery between 2020 and 2021. The subject was divided into two groups according to the median value of CIP which measured and recorded 12 h after admission to the ICU. Three Logistic regression models and restricted cubic spline (RCS) functions assessed the connections between the CIP and AKI. Propensity score matching (PSM) was applied to attenuate the confounding interference of the covariates.

RESULTS

A total of 279 pediatric patients were enrolled in this study, among which 64 patients developed AKI (22.94%). The median of CIP was 17mmHg. The incidence of AKI in the group of CIP>17mmHg was significantly higher than those in the group of CIP<17mmHg (47/159 vs. 17/120, P = 0.003).CIP monitored in patients with AKI was significantly higher than those without AKI at 12 h in ICU (19.5 vs. 18.0, p<0.001). The odds ratio of the full adjusted model was 2.35[(1.19 ~ 4.83), p = 0.016]. The results showed the same trend after PSM. No apparent non-linear relationship were found using RCS analysis.

CONCLUSIONS

This study offers preliminary evidence of an association between elevated CIP and higher risk of AKI following cardiac surgery in pediatric patients. CIP may serve as a potential and early risk factor for AKI after cardiac surgery. Given the observational design and potential for unmeasured confounding, these results should be considered hypothesis-generating. They are intended to inform the design of future prospective studies rather than to support immediate clinical intervention. TRIAL REGISTRATION: ClinicalTrials.gov Identifier ChiCTR2000034322 on July 2, 2020.