Furosemide Response Predicts Acute Kidney Injury after Cardiac Surgery in Infants and Neonates.

Objective: Cardiac surgery–induced acute kidney injury occurs frequently in neonates and infants and is associated with postoperative morbidity/mortality; early identification of cardiac surgery–induced acute kidney injury may be crucial to mitigate postoperative morbidity. We sought to determine if hourly or 6-hour cumulative urine output after furosemide in the first 24 hours after cardiopulmonary bypass could predict development of cardiac surgery–induced acute kidney injury and other deleterious outcomes. Design: Retrospective chart review. Setting: Pediatric cardiac ICU. Patients: All infants younger than 90 days old admitted to the cardiac ICU from October 2012 to December 2015 who received at least one dose of furosemide in the first 24 hours after cardiopulmonary bypass surgery. Interventions: None. Measurements and Main Results: Ninety-nine patients met inclusion and exclusion criteria. In total, 45.5% developed cardiac surgery–induced acute kidney injury. Median time between cardiopulmonary bypass and furosemide was 7.7 hours (interquartile range, 4.4–9.5). Six-hour cumulative urine output was 33% lower (p = 0.031) in patients with cardiac surgery–induced acute kidney injury. Area under the curve for prediction of cardiac surgery–induced acute kidney injury was 0.69 (p = 0.002). Other models demonstrated urine output response to furosemide had significant area under the curves for prediction of peak fluid over load greater than 15% (0.68; p = 0.047), prolonged peritoneal dialysis (area under the curve, 0.79; p = 0.007), prolonged mechanical ventilation (area under the curve, 0.79; p < 0.001), prolonged hospitalization (area under the curve, 0.62; p = 0.069) and mortality (area under the curve, 0.72; p = 0.05). Conclusions: Urine output response to furosemide within 24 hours of cardiopulmonary bypass predicts cardiac surgery–induced acute kidney injury development and other important morbidity in children younger than 90 days old; prospective validation is warranted.