• Nahmah Kim-Campbell, Catherine Gretchen, Clifton Callaway, Kathryn Felmet, Patrick M Kochanek, Timothy Maul, Peter Wearden, Mahesh Sharma, Melita Viegas, Ricardo Munoz, Mark T Gladwin, and Hülya Bayir.
• 1Department of Critical Care Medicine, UPMC and University of Pittsburgh, Pittsburgh, PA. 2Department of Emergency Medicine, UPMC and University of Pittsburgh, Pittsburgh, PA. 3Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 4Department of Cardiothoracic Surgery, UPMC and University of Pittsburgh, Pittsburgh, PA. 5Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, FL. 6Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA. 7Department of Medicine UPMC and University of Pittsburgh, Pittsburgh, PA.
• Crit. Care Med. 2017 Nov 1; 45 (11): e1123-e1130.

ObjectivesTo determine the relationship between the production of cell-free plasma hemoglobin and acute kidney injury in infants and children undergoing cardiopulmonary bypass for cardiac surgery.DesignProspective observational study.SettingTwelve-bed cardiac ICU in a university-affiliated children's hospital.PatientsChildren were prospectively enrolled during their preoperative outpatient appointment with the following criteria: greater than 1 month to less than 18 years old, procedures requiring cardiopulmonary bypass, no preexisting renal dysfunction.InterventionsNone.Measurements And Main ResultsPlasma and urine were collected at baseline (in a subset), the beginning and end of cardiopulmonary bypass, and 2 hours and 24 hours after cardiopulmonary bypass in 60 subjects. Levels of plasma hemoglobin increased during cardiopulmonary bypass and were associated (p < 0.01) with cardiopulmonary bypass duration (R = 0.22), depletion of haptoglobin at end and 24 hours after cardiopulmonary bypass (R = 0.12 and 0.15, respectively), lactate dehydrogenase levels at end cardiopulmonary bypass (R = 0.27), and change in creatinine (R = 0.12). Forty-three percent of patients developed acute kidney injury. There was an association between plasma hemoglobin level and change in creatinine that varied by age (overall [R = 0.12; p < 0.01]; in age > 2 yr [R = 0.22; p < 0.01]; and in < 2 yr [R = 0.03; p = 0.42]). Change in plasma hemoglobin and male gender were found to be risk factors for acute kidney injury (odds ratio, 1.02 and 3.78, respectively; p < 0.05).ConclusionsGeneration of plasma hemoglobin during cardiopulmonary bypass and male gender are associated with subsequent renal dysfunction in low-risk pediatric patients, especially in those older than 2 years. Further studies are needed to determine whether specific subgroups of pediatric patients undergoing cardiopulmonary bypass would benefit from potential treatments for hemolysis and plasma hemoglobin-associated renal dysfunction.

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