Pediatric Cardiologist Boston Children's Hospital Toronto, Ontario, Canada
Background: Acute renal failure (ARF) is associated with higher morbidity in patients with congenital heart disease (CHD). Limited data is available about the need for renal replacement therapy (RRT) in patients with CHD using large databases. Objective: To examine the association and outcomes of ARF and the need for RRT with different categories of CHD. Design/Methods: The national inpatient sample (NIS) dataset for the years 2016-2020 was examined. We identified infants who were born at or admitted to hospitals during their first year of life. We excluded infants with major congenital anomalies, renal anomalies, chromosomal disorders, and GA < 34 weeks. We categorized CHD patients based on underlying physiology into: Shunt lesions, cyanotic, left-sided, and single ventricle (SV) lesions. We calculated the frequency and percentages of the number of infants in each category. We calculated the prevalence of ARF and the need for RRT in each category. We calculated the odds ratios to have ARF or the need for dialysis in each category compared to the shunt lesion while controlling for confounding factors such as infant’s sex, race, and the occurrence of adverse events including sepsis, necrotizing enterocolitis, and arrhythmia. Results: There were 11,718,651 infants in the sample. CHD occurred in 2.1% and ARF occurred in 1.1%. Among CHD patients (n=248135), ARF occurred in 3.2% in infants with CHD compared to 0.06% of infants without CHD, adjusted OR (aOR) 29.4 (28.3-30.6), p < 0.001. Shunt lesions were the least complicated with ARF (2.1%) compared to 6.4% in cyanotic, 8% in left-sided lesions, and 15.3 % in SV patients (P < 0.001). RRT was needed in 0.25% vs 0.005% of infants with vs without CHD respectively, aOR 76 (67-86), p < 0.001. The odds ratio for RRT was 3.9 (3.7-4.2), 7.6 (5.8-10.0), and 8.3 (6.7-10.3) in cyanotic, left-sided, and SV patients respectively. Mortality was significantly higher in all CHD categories when comparing those who developed ARF compared to those without ARF [(5.3% vs 1.9%), (8.7% vs 2.5%), (20.9% vs 4.7%), and (32.7% vs 8.9%), P< 0.001 for all] in shunt, cyanotic, left-sided and SV patients respectively.
Conclusion(s): Infants with CHD are at high risk for ARF and need for RRT. SV and left-sided CHD were associated with the highest risk. ARF and the need for RRT were associated with substantially higher mortality in CHD patients. This significant risk of adverse outcomes is important to acknowledge when managing this patient population and counseling their families.
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