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Research Snapshot Theater: Cardiovascular, Pediatric IV

Relationship Between Renal Perfusion Pressure and AKI After Pediatric Cardiac Surgery

Tuesday, March 24, 2026
12:30 PM - 1:30 PM Central Time
Location: Connections Central - RST 07

  • Samuel R. Richey, M.D.

    University of Iowa Stead Family Children's Hospital, Iowa

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • KM

    Kyle A. Merrill, MD, MS

    Clinical Assistant Professor of Pediatrics and Nephrology
    University of Iowa Stead Family Children's Hospital, Iowa

    Disclosure information not submitted.

  • AB

    Aditya V. Badheka, MBBS, MS

    Clinical Professor of Pediatrics and Critical Care
    University of Iowa Hospital and Clinics, Iowa

    Disclosure information not submitted.

Introduction: Cardiac surgery-associated acute kidney injury (CS-AKI) affects almost half of children undergoing cardiac surgery and is associated with increased morbidity and mortality. Adult literature suggests lower renal perfusion pressure (RPP)—defined by mean arterial pressure (MAP) - central venous pressure (CVP)—after cardiac surgery is associated with increased CS-AKI risk. This study evaluates the relationship of MAP, CVP, and RPP to CS-AKI in children.


Methods: We performed a single-center retrospective study and included all children who underwent cardiac surgery from 2017-2024. We excluded infants < 30 days, children with dialysis dependence, or renal transplant in the prior 90 days. We collected demographics, intraoperative, and postoperative variables. Hourly MAP, CVP, and RPP was calculated daily on postoperative days (POD) 0-3. The primary outcome was AKI defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The relationship of MAP < 5th percentile for age and CVP > 5 mmHg to CS-AKI was assessed by Chi-square analysis. We performed univariate logistic regression on daily mean MAP, CVP, and RPP on AKI presence by POD3.


Results: In total, 663 patients were included: 48.6% had AKI, 35.8% had advanced AKI (KDIGO stage 2/3), 55.5% were male, and median age was 13 months. Children with >10% of MAP values < 5th percentile had statistically significant risk for developing CS-AKI (X2=16.5, p< 0.001). Children with >50% of CVP values > 5 mmHg had statistically significant risk for developing CS-AKI (X2= 9.28, p=0.002). CS-AKI risk increased by 2.7% per 1 mmHg CVP > 5 mmHg (OR 1.27, 95%CI [1.25-1.28], p< 0.001). Mean daily RPP < 35 mmHg was associated with significantly higher odds of development of CS-AKI by 42% (OR 1.42, 95%CI [1.29-1.57], p< 0.001).


Conclusions: Our study establishes a relationship between RPP, MAP, CVP, and CS-AKI risk in children who underwent cardiac surgery. MAP < 5th percentile for age, CVP > 5 mmHg, and RPP < 35 mmHg during POD0-3 were all independently associated with significantly higher risk of developing CS-AKI on POD3. Further multi-center and prospective studies are needed to better assess the relationship and impact of improving RPP on CS-AKI.