Abstract
BackgroundWith advances in care, neonates undergoing cardiac repairs are surviving more frequently. Our objectives were to 1) estimate the prevalence of chronic kidney disease (CKD) and hypertension 6 years after neonatal congenital heart surgery and 2) determine if cardiac surgery-associated acute kidney injury (CS-AKI) is associated with these outcomes.MethodsTwo-center prospective, longitudinal single-visit cohort study including children with congenital heart disease surgery as neonates between January 2005 and December 2012. CKD (estimated glomerular filtration rate < 90 mL/min/1.73m2 or albumin/creatinine ≥3 mg/mmol) and hypertension (systolic or diastolic blood pressure ≥ 95th percentile for age, sex, and height) prevalence 6 years after surgery was estimated. The association of CS-AKI (Kidney Disease: Improving Global Outcomes definition) with CKD and hypertension was determined using multiple regression.ResultsFifty-eight children with median follow-up of 6 years were evaluated. CS-AKI occurred in 58%. CKD and hypertension prevalence were 17% and 30%, respectively; an additional 15% were classified as having elevated blood pressure. CS-AKI was not associated with CKD or hypertension. Classification as cyanotic postoperatively was the only independent predictor of CKD. Postoperative days in hospital predicted hypertension at follow-up.ConclusionsThe prevalence of CKD and hypertension is high in children having neonatal congenital heart surgery. This is important; early identification of CKD and hypertension can improve outcomes. These children should be systematically followed for the evolution of these negative outcomes. CS-AKI defined by current standards may not be a useful clinical tool to decide who needs follow-up and who does not.
Highlights
Epidemiological studies have shown the prevalence of cardiac surgery-associated acute kidney injury (CS-AKI) to be as high as 50–60% in neonates [1, 2]
While much is known about the short-term outcomes of these patients, including prolonged ventilation, prolonged intensive care admission, and longer hospital stay [1, 3], there is less known about the long-term renal outcomes such as chronic kidney disease (CKD) and hypertension
The prevalence of CKD and hypertension is high in children having had congenital heart repair as neonates
Summary
Epidemiological studies have shown the prevalence of cardiac surgery-associated acute kidney injury (CS-AKI) to be as high as 50–60% in neonates [1, 2]. Chronic kidney disease causes significant personal and economic healthcare burden and is associated with worse long-term outcome, quality of life, and wellbeing in the general population [9] It is a condition where early identification and intervention to mitigate modifiable risks can delay progression. Our objectives were to 1) estimate the prevalence of chronic kidney disease (CKD) and hypertension 6 years after neonatal congenital heart surgery and 2) determine if cardiac surgery-associated acute kidney injury (CS-AKI) is associated with these outcomes. Conclusions The prevalence of CKD and hypertension is high in children having neonatal congenital heart surgery This is important; early identification of CKD and hypertension can improve outcomes. CS-AKI defined by current standards may not be a useful clinical tool to decide who needs follow-up and who does not
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