Metabolic Profiling with Acute Kidney Injury (AKI)

Research study background

Acute kidney injury (AKI) is a common but serious complication of cardiac surgery in children with congenital heart disease. Being of a younger age and the amount of time spent on cardiopulmonary bypass can increase the risk of occurrence. A study published in 2021, led by researchers at the Children’s Hospital Colorado Heart Institute, sought to determine differences in the circulating metabolic profile of infants with or without AKI after congenital heart disease surgery with cardiopulmonary bypass.

The study population comprised 57 infants under four months old, and data collection and analysis involved secondary analysis of pre- and post-operative samples, including:

• Metabolic profile of serum samples: 165 serum metabolites targeted with tandem mass spectrometry
• Compared infants who did or did not develop AKI in the first 72 hours after surgery

Study findings: 

• Eleven percent developed stage 2 or 3 AKI, according to the Kidney Disease Improving Global Outcomes classification 
• Twenty-three percent developed stage 1 acute kidney injury 
• No difference in pre-op metabolic profile with or without AKI 
• Moderate difference at 24 hours in those with severe AKI compared those without AKI, driven by 21 metabolites

Conclusions

Moderate-to-severe AKI after infant cardiac surgery was associated with changes in serum metabolome and three key dysregulated pathways: purine, methionine and kynurenine/nicotinamide metabolism.