TY - JOUR
T1 - Acute kidney injury and risk of CKD and hypertension after pediatric cardiac surgery
AU - Assessment Serial Evaluation Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Investigators
AU - Zappitelli, Michael
AU - Parikh, Chirag R.
AU - Kaufman, James S.
AU - Go, Alan S.
AU - Kimmel, Paul L.
AU - Hsu, Chi Yuan
AU - Coca, Steven G.
AU - Chinchilli, Vernon M.
AU - Greenberg, Jason H.
AU - Moxey-Mims, Marva M.
AU - Ikizler, T. Alp
AU - Cockovski, Vedran
AU - Dyer, Anne Marie
AU - Devarajan, Prasad
N1 - Funding Information:
This project was supported by National Institutes of Health, NIDDK grants UO1 DK082185, P50 DK096418 (to P. Devarajan), R01 DK098233 (to C. Hsu and A.S. Go), and K08 DK110536 (to J.H. Greenberg). M. Zappitelli received a Fonds de Recherche du Québec -Santé research salary award.
Funding Information:
S.G. Coca reports receiving grants, personal fees, and equity and stock options from RenalytixAI, during the conduct of the study. He also reports receiving personal fees from Bayer, Boehringer-Ingelheim, CHF Solutions, Relypsa, and Takeda, outside the submitted work. C. Hsu reports receiving royalties from UpToDate; consulting fees from EcoR1 Capital Fund, Ice Miller LLP, and Health Advances; personal fees from Satellite Healthcare; nonfinancial supportfromMicrolife;andgrantsfromSatelliteHealthcare,outside the submitted work. T. Alp Ikizler reports receiving personal fees fromAbbott Renal Care, FreseniusKabi,andInternationalSocietyof Nephrology, during the conduct of the study. J.S. Kaufman reports receiving personal fees from NIDDK, during the conduct of the study. C.R. Parikh reports receiving consulting fees from Akebia Therapeutics, Inc. and Genfit Biopharmaceutical Company; grants from NIDDK and National Heart, Lung and Blood Institute; and other from Renaltix AI, outside the submitted work. P.L. Kimmel is the coeditor of Chronic Renal Disease (Second Edition, Academic Press, San Diego, CA, 2020). He is also employed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the funder of the study. M.M. Moxey-Mims was employed by the NIDDK during the conduct of the study. All remaining authors have nothing to disclose.
Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/10
Y1 - 2020/10
N2 - Background and objectives The association of AKI after pediatric cardiac surgery with long-term CKD and hypertension development is unclear. The study objectives were to determine whether AKI after pediatric cardiac surgery is associated with incident CKD and hypertension. Design, setting, participants, & measurements This was a prospective cohort study of children of 1 month to 18 years old who were undergoing cardiac surgery at two tertiary care centers (Canada, United States). Participants were recruited before cardiac surgery and were followed during hospitalization and at 3, 12, 24, 36, and 48 months after discharge. Exposures were postoperative AKI, based on the Kidney Disease Improving Global Outcomes (KDIGO) definition, and age,2 years old at surgery. Outcomes and measures were CKD (low eGFR or albuminuria for age) and hypertension (per the 2017 American Academy of Pediatrics guidelines) at follow-up, with the composite outcome of CKD or hypertension. Results Among 124 participants, 57 (46%) developed AKI. AKI versus non-AKI participants had a median (interquartile range) age of 8 (4.8–40.8) versus 46 (6.0–158.4) months, respectively, and higher preoperative eGFR. From the 3-to 48-month follow-up, the cohort prevalence of CKD was high (17%–20%); hypertension prevalence was also high (22%–30%). AKI was not significantly associated with the development of CKD throughout followup. AKI was associated with hypertension development at 12 months after discharge (adjusted relative risk, 2.16; 95% confidence interval, 1.18 to 3.95), but not at subsequent visits. Children aged,2yearsoldatsurgeryhada significantly higher prevalence of hypertension during follow-up than older children (40% versus 21% at 3-month follow-up; 32% versus 13% at 48-month follow-up). Conclusions CKD and hypertension burden in the 4 years after pediatric cardiac surgery is high. Young age at surgery, but not AKI, is associated with their development.
AB - Background and objectives The association of AKI after pediatric cardiac surgery with long-term CKD and hypertension development is unclear. The study objectives were to determine whether AKI after pediatric cardiac surgery is associated with incident CKD and hypertension. Design, setting, participants, & measurements This was a prospective cohort study of children of 1 month to 18 years old who were undergoing cardiac surgery at two tertiary care centers (Canada, United States). Participants were recruited before cardiac surgery and were followed during hospitalization and at 3, 12, 24, 36, and 48 months after discharge. Exposures were postoperative AKI, based on the Kidney Disease Improving Global Outcomes (KDIGO) definition, and age,2 years old at surgery. Outcomes and measures were CKD (low eGFR or albuminuria for age) and hypertension (per the 2017 American Academy of Pediatrics guidelines) at follow-up, with the composite outcome of CKD or hypertension. Results Among 124 participants, 57 (46%) developed AKI. AKI versus non-AKI participants had a median (interquartile range) age of 8 (4.8–40.8) versus 46 (6.0–158.4) months, respectively, and higher preoperative eGFR. From the 3-to 48-month follow-up, the cohort prevalence of CKD was high (17%–20%); hypertension prevalence was also high (22%–30%). AKI was not significantly associated with the development of CKD throughout followup. AKI was associated with hypertension development at 12 months after discharge (adjusted relative risk, 2.16; 95% confidence interval, 1.18 to 3.95), but not at subsequent visits. Children aged,2yearsoldatsurgeryhada significantly higher prevalence of hypertension during follow-up than older children (40% versus 21% at 3-month follow-up; 32% versus 13% at 48-month follow-up). Conclusions CKD and hypertension burden in the 4 years after pediatric cardiac surgery is high. Young age at surgery, but not AKI, is associated with their development.
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U2 - 10.2215/CJN.00150120
DO - 10.2215/CJN.00150120
M3 - Article
C2 - 32948644
AN - SCOPUS:85092250093
SN - 1555-9041
VL - 15
SP - 1403
EP - 1412
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 10
ER -