ESPN 54th Annual Meeting

ESPN 2022


 
PERSISTENT MARKERS OF RENAL INJURY FOLLOWING CARDIAC SURGERY-RELATED ACUTE KIDNEY INJURY IN CHILDHOOD: A PROSPECTIVE COHORT STUDY
JEF VAN DEN EYNDE 1 THOMAS SALAETS 2 JACOBA LOUW 3 JEAN HERMAN 4 LUC BREYSEM 5 DIRK VLASSELAERS 6 LARS DESMET 6 BART MEYNS 7 WERNER BUDTS 8 MARC GEWILLIG 2 DJALILA MEKAHLI 9

1- DEPARTMENT OF CARDIOVASCULAR SCIENCES, KU LEUVEN, LEUVEN, BELGIUM.
2- PEDIATRIC CARDIOLOGY, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
3- PEDIATRIC CARDIOLOGY, MAASTRICHT UNIVERSITY MEDICAL CENTRE, MAASTRICHT, THE NETHERLANDS.
4- DEPARTMENT OF PEDIATRIC NEPHROLOGY, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
5- DEPARTMENT OF RADIOLOGY, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
6- DEPARTMENT OF INTENSIVE CARE MEDICINE, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
7- DEPARTMENT OF CARDIOVASCULAR DISEASES, UNIT OF CARDIAC SURGERY, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
8- CONGENITAL AND STRUCTURAL CARDIOLOGY, UNIVERSITY HOSPITALS LEUVEN, LEUVEN, BELGIUM.
9- PKD RESEARCH GROUP, GPURE, DEPARTMENT OF DEVELOPMENT AND REGENERATION, KU LEUVEN, LEUVEN, BELGIUM.
 
Introduction:

This prospective cohort study investigated the long-term renal consequences and prevalence of chronic kidney disease (CKD) following acute kidney injury (AKI) after pediatric cardiac surgery for congenital heart disease (CHD).

Material and methods:

All eligible children (<16 years) who had developed AKI following cardiac surgery at our center between December 2004 and December 2008 were prospectively invited for a formal renal assessment 5 years after AKI. Longer follow-up data on renal function (>10 years after AKI) were collected at latest available visit.

Results:

Among 571 patients operated over a 4-year period, AKI occurred in 113 (19.7%). 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 one marker of kidney injury, including estimated glomerular filtration rate (eGFR) <90mL/min/1.73m² in 9 (13.6%), proteinuria in 27 (40.9%), alpha-1-microglobinuria in 5 (7.6%), hypertension in 13 (19.7%), and abnormalities on kidney ultrasound in 9 (13.6%). CKD stages 1-5 was present in 18 (27.3%). CKD was associated with syndromes (55.6% vs 20.8%, p=0.015). At 13.1 years (IQR 11.2-14.0) follow-up, eGFR <90mL/min/1.73m² was present in 18/49 patients (36.7%), suggesting an average eGFR decline rate of -1.81 mL/min/1.73m² per year.

Conclusions:

Children who developed AKI after pediatric cardiac surgery show persistent markers of renal injury. Detection and treatment of CKD, proteinuria, and hypertension in children is critical because these are risk factors for cardiovascular diseases and progressive renal damage in adults. Prevention of renal disease should start in childhood to ensure optimal outcomes in the growing population of adults with CHD.