Kidney Outcomes 5 Years After Pediatric Cardiac Surgery: The TRIBE-AKI Study.

Abstract

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.

• Authors: Jason H Greenberg, Michael Zappitelli, Prasad Devarajan, Heather R Thiessen-Philbrook, Catherine Krawczeski, Simon Li, Amit X Garg, Steve Coca, Chirag R Parikh, TRIBE-AKI Consortium
• Journal: JAMA pediatrics (JAMA Pediatr) Vol. 170 Issue 11 Pg. 1071-1078 (11 01 2016) ISSN: 2168-6211 [Electronic] United States
• PMID: 27618162 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)

Chemical References

• Biomarkers
• Creatinine

Topics

• Acute Kidney Injury (blood, etiology)
• Adolescent
• Biomarkers (blood)
• Cardiac Surgical Procedures (adverse effects)
• Cardiopulmonary Bypass (adverse effects)
• Child
• Child, Preschool
• Cohort Studies
• Creatinine (blood)
• Female
• Follow-Up Studies
• Heart Defects, Congenital (blood, surgery)
• Humans
• Infant
• Male
• Postoperative Complications (blood, diagnosis)