Clinical and Pathophysiological Determinants of Cardiac Surgery–Associated Acute Kidney Injury in Young Children: The Role of Preoperative and Intraoperative Factors

Cardiac surgery–associated acute kidney injury (CSA-AKI) in young children is a common and clinically significant complication following surgical correction of congenital heart defects, developing as a result of the combined impact of baseline renal vulnerability and intraoperative perfusion stress. Objective. To identify clinical and pathophysiological risk factors for CSA-AKI and to determine independent predictors of its development in young children. The study included 585 children under 3 years of age who underwent cardiac surgery with cardiopulmonary bypass. CSA-AKI was diagnosed according to KDIGO criteria. Preoperative and intraoperative factors were analyzed using univariate and multivariate statistical methods. CSA-AKI developed in 224 patients (38.3%). At the preoperative stage, significant risk factors included heart failure, hypoxemia, low body weight, and high complexity of congenital heart defects. In the intraoperative period, the risk of CSA-AKI was significantly associated with cardiopulmonary bypass duration >90 minutes, hyperlactatemia, hematocrit <25%, and reduced urine output. Multivariate analysis identified elevated lactate levels, prolonged perfusion duration, hemodilution, and early renal functional response as independent predictors. CSA-AKI in young children is determined by a combination of preoperative and intraoperative factors reflecting impaired systemic perfusion and oxygen delivery. Early risk stratification and targeted control of modifiable perfusion parameters are essential for prevention.

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