Iranian Heart Journal

Iranian Heart Journal

Renal Function in Children With Congenital Heart Disease After Cardiopulmonary Bypass

Document Type : Original Article

Authors
Negar Saadaat Haidari 1
Saeed Abtahi 2
Mahmood Hosseinzadeh Maliki 3
Farhad Samadieh 3
Fereshteh Najafi 4
1 Student Research Committee, Faculty of Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, IR Iran.
2 Faculty of Medicine, Mashhad Medical Sciences Branch, Islamic Azad University, Mashhad, IR Iran.
3 Department of Cardiac Surgery, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Kidney dysfunction is a known complication in children with congenital heart disease (CHD). While numerous studies have explored risk factors for nephropathy in this population, research specifically comparing renal function before and after open-heart surgery remains limited. This study aimed to evaluate kidney function in children with CHD both before and after cardiopulmonary bypass and open-heart surgery.
 
Methods: This prospective observational study included children with CHD, aged 1 month to 5 years, who underwent open-heart surgery. Demographic information and serum levels of creatinine, urea, albumin, and glomerular filtration rate (GFR) were collected at 24 hours pre-surgery and at 24, 48, and 72 hours, and 1 week post-surgery. Data analysis and comparisons were performed based on the type of CHD (cyanotic versus acyanotic).
 
Findings: Twenty-six cyanotic and 40 acyanotic children with CHD, with a mean age of 16.34 ± 15.50 months, were included in the study. Serum levels of creatinine, urea, and albumin significantly increased 24 hours after the operation (P <0.05). GFR significantly decreased at 24 and 48 hours postoperatively (P <0.05). Moreover, 72 hours after the operation, creatinine levels were significantly higher in the cyanotic group than in the acyanotic group (P =0.007). At 24 hours (P =0.02) and 72 hours (P =0.05) postoperatively, higher mean urea levels were observed in the cyanotic group. Patients undergoing surgeries lasting over 60 minutes had higher serum urea levels than those with shorter surgical durations (P =0.05).
 
Conclusions: These results suggest that renal function indices were altered during the first two days following open-heart surgery in children with CHD. (Iranian Heart Journal 2025; 26(4): 6-14)
Keywords
Congenital heart disease
Kidney function
Open-heart surgery
Cardiopulmonary bypass
  1. Fahed AC, Gelb BD, Seidman J, Seidman CE. Genetics of congenital heart disease: the glass half empty. Circulation research. 2013; 112(4):707-720.
  2. Rao PS. Diagnosis and management of cyanotic congenital heart disease: part I. The Indian Journal of Pediatrics. 2009; 76:57-70.
  3. Van Der Linde D, Konings EE, Slager MA, et al. Birth prevalence of congenital heart disease worldwide: a systematic review and meta-analysis. Journal of the American College of Cardiology. 2011; 58(21):2241-2247.
  4. Rohit M, Shrivastava S. Acyanotic and cyanotic congenital heart diseases. The Indian Journal of Pediatrics. 2018; 85:454-460.
  5. Asrani SK, Asrani NS, Freese DK, et al. Congenital heart disease and the liver. Hepatology. 2012; 56(3):1160-1169.
  6. Morgan C, Al-Aklabi M, Guerra GG. Chronic kidney disease in congenital heart disease patients: a narrative review of evidence. Canadian journal of kidney health and disease. 2015; 2:63.
  7. Agras PI, Derbent M, Ozcay F, et al. Effect of congenital heart disease on renal function in childhood. Nephron Physiology. 2005; 99(1):p10-p15.
  8. Awad H, El-Said S, El-Safty I, Abdel-Gawad M. Glomerular and tubular dysfunction in children with congenital cyanotic heart disease: effect of palliative surgery. The American journal of the medical sciences. 2003; 325(3):110-114.
  9. Amoozgar H, Basiratnia M, Ghasemi F. Renal function in children with cyanotic congenital heart disease: pre-and post-cardiac surgery evaluation. Iranian Journal of Pediatrics. 2014; 24(1):81.
  10. El Sayegh S, Ephrem G, Wish JB, Moe S, Lim K. Kidney disease and congenital heart disease: Partnership for life. Frontiers in physiology. 2022; 13:970389. doi:10.3389/fphys.2022.970389
  11. Ali F, Sr., Khan MK, Mirza B, Qureshi S, Jr., Abbas Q. Acute Kidney Injury after Congenital Heart Disease Surgery: A Single-Center Experience in a Low- to Middle-Income Country. Cureus. Apr 18 2020; 12(4):e7727. doi:10.7759/cureus.7727
  12. Li S, Krawczeski CD, Zappitelli M, et al. Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Critical care medicine. 2011; 39(6):1493-1499.
  13. Aoun B, Daher GA, Daou KN, et al. Acute Kidney Injury Post-cardiac Surgery in Infants and Children: A Single-Center Experience in a Developing Country. Frontiers in Pediatrics. 2021; 9:637463.
  14. Yuan S-M. Acute kidney injury after cardiac surgery: risk factors and novel biomarkers. Brazilian Journal of Cardiovascular Surgery. 2019; 34:352-360.
  15. Pedersen K, Povlsen J, Christensen S, et al. Risk factors for acute renal failure requiring dialysis after surgery for congenital heart disease in children. Acta anaesthesiologica scandinavica. 2007; 51(10):1344-1349.
  16. Schwartz G, Haycock G, Edelmann Jr C, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976; 58(2):259-263.
  17. Zappitelli M, Bernier P-L, Saczkowski RS, et al. A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney international. 2009; 76(8):885-892.
  18. Basile DP, Anderson MD, Sutton TA. Pathophysiology of acute kidney injury. Comprehensive Physiology. Apr 2012; 2(2):1303-53. doi:10.1002/cphy.c110041
  19. Hongsawong N, Khamdee P, Silvilairat S, Chartapisak W. Prevalence and associated factors of renal dysfunction and proteinuria in cyanotic congenital heart disease. Pediatric Nephrology. 2018; 33:493-501.
  20. Sethi SK, Kumar M, Sharma R, Bazaz S, Kher V. Acute kidney injury in children after cardiopulmonary bypass: risk factors and outcome. Indian pediatrics. 2015; 52:223-226.
Iranian Heart Journal
Volume 26, Issue 4
Autumn 2025
Pages 6-14