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Persistent Markers of Kidney Injury in Children Who Developed Acute Kidney Injury After Pediatric Cardiac Surgery: A
Jef Van den Eynde1,2, Thomas Salaets1,3, Jacoba J Louw4
1Department of Cardiovascular Sciences KU Leuven Leuven Belgium.
Insights
Pediatric cardiac surgery patients with acute kidney injury (AKI) often develop chronic kidney disease (CKD). Long-term follow-up is crucial for monitoring kidney function and cardiovascular health in these children.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Surgery Outcomes
- Renal Medicine
Background:
- Acute kidney injury (AKI) is a frequent complication following pediatric cardiac surgery.
- Long-term renal outcomes, including the development of chronic kidney disease (CKD), after pediatric AKI remain poorly understood.
Purpose of the Study:
- To investigate the long-term kidney function and CKD incidence in children who experienced AKI after cardiac surgery.
- To identify markers of persistent kidney injury and assess the rate of estimated glomerular filtration rate (eGFR) decline.
Main Methods:
- Prospective follow-up assessment of children (<16 years) with prior AKI post-cardiac surgery, approximately 5 years after the event.
- Evaluations included eGFR, proteinuria, α1-microglobulin levels, blood pressure, kidney ultrasound, and long-term kidney function data collection.
- Analysis of CKD prevalence and association with other clinical factors.
Main Results:
- Of 113 children with AKI, 66 underwent assessment at a median of 4.8 years post-AKI.
- 59.1% showed at least one marker of kidney injury; 27.3% had CKD (Stages 1-5).
- Long-term follow-up (13.1 years) revealed eGFR <90 mL/min/1.73 m² in 36.7% of patients, with an average eGFR decline rate of -1.81 mL/min/1.73 m²/year.
Conclusions:
- Children surviving AKI after pediatric cardiac surgery exhibit persistent kidney injury markers and a significant risk of developing CKD.
- The findings underscore the necessity for long-term renal monitoring in this vulnerable pediatric population.
- CKD is a known risk factor for cardiovascular comorbidity, highlighting the importance of proactive kidney care.
Abstract:
Background Acute kidney injury (AKI) after pediatric cardiac surgery is common. Longer-term outcomes and the incidence of chronic kidney disease after AKI are not well-known. Methods and Results All eligible children (aged <16 years) who had developed AKI following cardiac surgery at our tertiary referral hospital were prospectively invited for a formal kidney assessment ≈5 years after AKI, including measurements of estimated glomerular filtration rate, proteinuria, α1-microglobulin, blood pressure, and kidney ultrasound. Longer-term follow-up data on kidney function were collected at the latest available visit. Among 571 patients who underwent surgery, AKI occurred in 113 (19.7%) over a 4-year period. Fifteen of these (13.3%) died at a median of 31 days (interquartile range [IQR], 9-57) after surgery. A total of 66 patients participated in the kidney assessment at a median of 4.8 years (IQR, 3.9-5.7) after the index AKI episode. Thirty-nine patients (59.1%) had at least 1 marker of kidney injury, including estimated glomerular filtration rate <90 mL/min per 1.73 m2 in 9 (13.6%), proteinuria in 27 (40.9%), α1-microglobinuria in 5 (7.6%), hypertension in 13 (19.7%), and abnormalities on kidney ultrasound in 9 (13.6%). Stages 1 to 5 chronic kidney disease were present in 18 (27.3%) patients. Patients with CKD were more likely to have an associated syndrome (55.6% versus 20.8%, P=0.015). At 13.1 years (IQR, 11.2-14.0) follow-up, estimated glomerular filtration rate <90 mL/min per 1.73 m² was present in 18 of 49 patients (36.7%), suggesting an average estimated glomerular filtration rate decline rate of -1.81 mL/min per 1.73 m² per year. Conclusions Children who developed AKI after pediatric cardiac surgery showed persistent markers of kidney injury. As chronic kidney disease is a risk factor for cardiovascular comorbidity, long-term kidney follow-up in this population is warranted.
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