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Kidney Outcomes 5 Years After Pediatric Cardiac Surgery: The TRIBE-AKI Study
Jason H Greenberg1, Michael Zappitelli2, Prasad Devarajan3
1Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut2Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
Insights
Pediatric cardiac surgery patients frequently develop chronic kidney disease and hypertension 5 years post-op. However, acute kidney injury (AKI) during surgery did not predict these long-term kidney outcomes.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery Outcomes
- Renal Function Monitoring
Background:
- Acute kidney injury (AKI) following pediatric cardiac surgery is linked to significant short-term complications.
- Long-term kidney health after these procedures remains incompletely understood.
Purpose of the Study:
- To evaluate the long-term kidney outcomes in children after cardiac surgery.
- To determine if perioperative AKI impacts these long-term renal outcomes.
Main Methods:
- Prospective cohort study of 131 children (1 month to 18 years) undergoing cardiopulmonary bypass.
- Follow-up included telephone calls and an in-person visit at 5 years post-surgery.
- AKI defined by postoperative serum creatinine increase; outcomes included hypertension, microalbuminuria, and chronic kidney disease (CKD).
Main Results:
- At 5-year follow-up, 17% had hypertension and 18% had CKD.
- Prevalence of hypertension was 10 times higher than the general pediatric population.
- No significant difference in renal outcomes was observed between children with and without perioperative AKI.
Conclusions:
- Chronic kidney disease and hypertension are prevalent 5 years after pediatric cardiac surgery.
- Perioperative AKI was not associated with increased risk of these long-term complications.
- Extended follow-up is necessary to track the progression of renal conditions.
Importance:
Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high short-term morbidity and mortality; however, the long-term kidney outcomes are unclear.
Objective:
To assess long-term kidney outcomes after pediatric cardiac surgery and to determine if perioperative AKI is associated with worse long-term kidney outcomes.
Design, Setting, And Participants:
This prospective multicenter cohort study recruited children between ages 1 month to 18 years who underwent cardiopulmonary bypass for cardiac surgery and survived hospitalization from 3 North American pediatric centers between July 2007 and December 2009. Children were followed up with telephone calls and an in-person visit at 5 years after their surgery.
Exposures:
Acute kidney injury defined as a postoperative serum creatinine rise from preoperative baseline by 50% or 0.3 mg/dL or more during hospitalization for cardiac surgery.
Main Outcomes And Measures:
Hypertension (blood pressure ≥95th percentile for height, age, sex, or self-reported hypertension), microalbuminuria (urine albumin to creatinine ratio >30 mg/g), and chronic kidney disease (serum creatinine estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 or microalbuminuria).
Results:
Overall, 131 children (median [interquartile range] age, 7.7 [5.9-9.9] years) participated in the 5-year in-person follow-up visit; 68 children (52%) were male. Fifty-seven of 131 children (44%) had postoperative AKI. At follow-up, 22 children (17%) had hypertension (10 times higher than the published general pediatric population prevalence), while 9 (8%), 13 (13%), and 1 (1%) had microalbuminuria, an eGFR less than 90 mL/min/1.73 m2, and an eGFR less than 60 mL/min/1.73 m2, respectively. Twenty-one children (18%) had chronic kidney disease. Only 5 children (4%) had been seen by a nephrologist during follow-up. There was no significant difference in renal outcomes between children with and without postoperative AKI.
Conclusions And Relevance:
Chronic kidney disease and hypertension are common 5 years after pediatric cardiac surgery. Perioperative AKI is not associated with these complications. Longer follow-up is needed to ascertain resolution or worsening of chronic kidney disease and hypertension.
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