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J Pediatr Intensive Care
DOI: 10.1055/s-0043-57234
Original Article

Higher Dosage of Acetaminophen Associated with Lower Risk of Acute Kidney Injury after Pediatric Cardiac Surgery

Melissa Nater 
1   Department of Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Joshua Wong
1   Department of Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Nobuyuki Ikeda
1   Department of Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Brian Heenan
1   Department of Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Rohit S. Loomba
1   Department of Pediatric Cardiology, Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States
,
Jamie Penk
2   Department of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
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Abstract

Acute kidney injury (AKI) after pediatric cardiac surgery is manifested by injury along multiple pathways. One of these is oxidative injury related to hemolysis and subsequent deposition of hemoglobin in the kidney. Acetaminophen inhibits hemoprotein-catalyzed lipid peroxidation associated with hemolysis and in turn, may attenuate renal injury. We performed a retrospective chart review of patients undergoing pediatric cardiac surgery. A randomized controlled trial previously performed dictated a regimented, high dosage, acetaminophen. A historical cohort who received ad hoc acetaminophen prior to that study and that met the same inclusion/exclusion criteria were also analyzed, as patients from that era were likely to have less acetaminophen administered. The patients were divided into those who developed AKI and those who did not and those groups were compared by total acetaminophen dose. Important inclusion criteria included age 3 months to 4 years who underwent cardiac surgery via midline sternotomy and were extubated within 3 hours of admission. Patients with preexisting or chronic kidney disease were excluded. A total of 181 patients were included. Of these, 69 (38%) developed AKI. There were no significant pre- or intraoperative risk differences in characteristics between those who developed AKI and those who did not. Acetaminophen dose did significantly differ between those who developed AKI and those who did not with lower acetaminophen dose in the AKI group (30 vs. 50 mg/kg, p-value = 0.01). A multivariate analysis was performed which found that higher acetaminophen dosage and lower immediate postoperative hemoglobin were independently associated with a lower risk of AKI. AKI occurs in ∼38% after pediatric cardiac surgery. Most often this is stage 1 AKI and resolves after a day. After adjusting for other covariables, higher acetaminophen dose may be associated with lower risk of AKI. This does not prove that acetaminophen given prospectively will reduce AKI. Further studies are needed.

Keywords

acute kidney injury - pediatric cardiac surgery - acetaminophen


Publication History

Received: 12 August 2022

Accepted: 15 March 2023

Article published online:
18 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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