Perioperative acute kidney injury may not confer other poor outcomes after pediatric cardiac surgery
Perioperative acute kidney injury is not linked to the common occurrences of chronic kidney disease and hypertension 5 years after pediatric cardiac surgery, according to a study published in JAMA Pediatrics.
However, the researchers wrote longer follow-up is needed to gauge resolution or worsening of chronic kidney disease and hypertension.
Jason H. Greenberg , MD , MHS, from the nephrology section, department of pediatrics, and the Program of Applied Translational Research, Yale University School of Medicine, and colleagues assessed long-term kidney outcomes after pediatric cardiac surgery to determine whether perioperative acute kidney injury (AKI) is associated with worse long-term kidney outcomes. AKI after pediatric cardiac surgery is linked to high short-term morbidity and mortality, but long-term kidney outcomes remain unclear, the researchers wrote.
For the TRIBE-AKI study, AKI was defined as a postoperative serum creatinine increase from baseline by 50% or 0.3 mg/dL or more while a child was hospitalized for cardiac surgery.
The researchers analyzed data from 131 children aged 1 month to 18 years (median age, 7.7 years; 52% boys) who were hospitalized at three North American pediatric centers between July 2007 and December 2009 for cardiopulmonary bypass and survived.
The patients were followed up with phone calls and an in-person visit at 5 years after their surgery.
The researchers found 57 of 131 children (44%) had postoperative AKI. At 5 years, 17% had hypertension, a rate 10 times higher than in the general pediatric population, according to the researchers.
Also, 8% of the children had microalbuminuria, 13% had an estimated glomerular filtration rate less than 90 mL/min/1.73 m2 and 1% had a rate less than 60 mL/min/1.73 m2.
Although 18% of the children had chronic kidney disease, just 4% were examined by a nephrologist during follow-up. Children with and without postoperative AKI displayed no significant differences in renal outcomes, Greenberg and colleagues wrote.
“(Hypertension prevalence) is especially significant and remarkable because our cohort was much younger than those reported elsewhere and would therefore be expected to display a lower prevalence of hypertension,” the researchers wrote. “A potential explanation could be the presence of underlying congenital heart disease in our cohort.” – by James Clark
Disclosure: Greenberg reports no relevant disclosures. One researcher reports being a co-inventor on the neutrophil gelatinase-associated lipocalin patent.