REVIEW OF CURRENT RESEARCH ON THE ROLE OF PERIOPERATIVE RISK FACTORS AND PROGNOSTIC VALUE OF LEADING BIOMARKERS IN THE OCCURRENCE OF ACUTE KIDNEY INJURY IN CHILDREN AFTER CARDIAC SURGERY (LITERATURE REVIEW)

Ainamkoz Amanzholova, Marina Morenko, Bolat Bekishev, G.K. Besbayeva, Dariga Koichubayeva, Kamilla Rakhimova, Kaiyrgeldi Ashim

2025

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DOI 10.53511/pharmkaz.2025.78.64.002
Data confidence 85 high
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Abstract

Acute kidney injury (AKI) is a common and serious complication in children after cardiac surgery, associated with prolonged intensive care and increased mortality. Despite advances in cardiac surgery and perioperative care, AKI incidence remains high (affecting up to 40–60% of high-risk pediatric patients). This review aims to analyze perioperative risk factors and evaluate the prognostic value of key biomarkers for AKI in pediatric cardiac surgery patients. Methods: A literature review of recent studies (published up to 2023) on pediatric AKI following cardiac surgery was performed, focusing on perioperative risk factors and early AKI biomarkers. Results: Identified perioperative risk factors include preoperative factors (low body weight, young age, complex congenital heart defects, prior cardiac surgery, and critical preoperative state), intraoperative factors (prolonged cardiopulmonary bypass and circulatory arrest), and postoperative factors (hypotension, high-dose inotropes, and fluid overload), all associated with increased AKI risk. Emerging biomarkers for early AKI detection show promising prognostic value. Novel biomarkers such as NGAL, KIM-1, IL-18, FGF23, and the combined TIMP-2/IGFBP-7 index have demonstrated utility in early AKI diagnosis. In particular, urinary NGAL exhibits high sensitivity, and an early postoperative rise in urinary KIM-1 correlates with subsequent AKI development. However, serum creatinine and urine output remain the standard diagnostic criteria despite being late markers of injury. Discussion: Early identification of high-risk patients using perioperative factors and biomarkers can enable timely interventions to prevent or mitigate AKI, potentially improving postoperative outcomes (shorter ICU stay and lower mortality). However, further research is needed to standardize AKI definitions, establish optimal biomarker thresholds, and confirm that novel biomarkers improve clinical outcomes. This review highlights the need for continued research and the integration of new biomarkers into clinical practice for better prevention and management of AKI in children after cardiac surgery.