Perioperative Acute Kidney Injury and Prognosis of Infants With Down Syndrome and Congenital Heart Disease

Background Children with Down syndrome (DS) often have hypoplastic kidneys and urinary tract malformations that increase their renal dysfunction risk. They also have a higher congenital heart disease (CHD) rate, requiring cardiac surgery during infancy. Renal dysfunction in such patients may be associated with the development of cardiac surgery-associated acute kidney injury (CS-AKI), but this remains unclear. In this study, we compared the incidence, severity, and prognosis of CS-AKI between infants with and without DS complicated by CHD. Methods We retrospectively analyzed 144 consecutive infants with (n=59) and without (n=85) DS who underwent cardiac surgery for CHD between January 2013 and October 2018. The primary endpoint was CS-AKI incidence, and the secondary endpoints were CS-AKI severity and perioperative prognosis. We assessed the severity of CS-AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Results The DS group had significantly smaller kidney size when measured by ultrasound at birth than the non-DS group (P<0.001). Preoperative renal function assessment revealed significantly higher serum creatinine (Cr, 0.29 vs. 0.20 mg/dL, P<0.001) and lower Cr-estimated glomerular filtration rates (82.0 vs. 101.4 mL/min/1.73 m², P<0.001) in the DS group than in the non-DS group. CS-AKI incidence and severity did not differ between the groups. Risk factors for CS-AKI incidence included being younger at the time of cardiac surgery and a prolonged cardiopulmonary bypass in the overall cohort and DS group. Conclusions The incidence and severity of CS-AKI did not differ between the DS and non-DS groups. Understanding potential renal dysfunction and managing patients with DS and CHD may assist in preventing perioperative acute kidney injury after cardiac surgery.