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Original ArticlesAcute Kidney Injury and ICU Nephrology
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Acute Kidney Injury and Risk of CKD and Hypertension after Pediatric Cardiac Surgery

Michael Zappitelli, Chirag R. Parikh, James S. Kaufman, Alan S. Go, Paul L. Kimmel, Chi-yuan Hsu, Steven G. Coca, Vernon M. Chinchilli, Jason H. Greenberg, Marva M. Moxey-Mims, T. Alp Ikizler, Vedran Cockovski, Anne-Marie Dyer, Prasad Devarajan and for the ASsessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Investigators
CJASN October 2020, 15 (10) 1403-1412; DOI: https://doi.org/10.2215/CJN.00150120
Michael Zappitelli
1Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Chirag R. Parikh
2Division of Nephrology, Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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James S. Kaufman
3Veterans Affairs New York Harbor Healthcare System, New York University School of Medicine, New York, New York
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Alan S. Go
4Division of Research, Kaiser Permanente Northern California, Oakland, California
5Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
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Paul L. Kimmel
6National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Chi-yuan Hsu
4Division of Research, Kaiser Permanente Northern California, Oakland, California
5Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California
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Steven G. Coca
7Division of Nephrology, Department of Medicine, Icahn School of Medicine, Mount Sinai, New York
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Vernon M. Chinchilli
8Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Jason H. Greenberg
9Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut
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Marva M. Moxey-Mims
10Division of Nephrology, Children’s National Hospital, Washington, DC
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T. Alp Ikizler
11Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
12Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Veteran’s Health Administration, Nashville, Tennessee
13Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee
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Vedran Cockovski
1Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Anne-Marie Dyer
8Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania
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Prasad Devarajan
14Department of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Abstract

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 follow-up. 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 <2 years old at surgery had a 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.

  • acute renal failure
  • chronic kidney disease
  • clinical hypertension
  • pediatric nephrology
  • pediatric intensive care medicine
  • epidemiology and outcomes
  • acute kidney injury
  • Received January 4, 2020.
  • Accepted August 4, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (10)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 10
October 07, 2020
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Acute Kidney Injury and Risk of CKD and Hypertension after Pediatric Cardiac Surgery
Michael Zappitelli, Chirag R. Parikh, James S. Kaufman, Alan S. Go, Paul L. Kimmel, Chi-yuan Hsu, Steven G. Coca, Vernon M. Chinchilli, Jason H. Greenberg, Marva M. Moxey-Mims, T. Alp Ikizler, Vedran Cockovski, Anne-Marie Dyer, Prasad Devarajan, for the ASsessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Investigators
CJASN Oct 2020, 15 (10) 1403-1412; DOI: 10.2215/CJN.00150120

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Acute Kidney Injury and Risk of CKD and Hypertension after Pediatric Cardiac Surgery
Michael Zappitelli, Chirag R. Parikh, James S. Kaufman, Alan S. Go, Paul L. Kimmel, Chi-yuan Hsu, Steven G. Coca, Vernon M. Chinchilli, Jason H. Greenberg, Marva M. Moxey-Mims, T. Alp Ikizler, Vedran Cockovski, Anne-Marie Dyer, Prasad Devarajan, for the ASsessment, Serial Evaluation, and Subsequent Sequelae in Acute Kidney Injury (ASSESS-AKI) Investigators
CJASN Oct 2020, 15 (10) 1403-1412; DOI: 10.2215/CJN.00150120
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Keywords

  • acute renal failure
  • chronic kidney disease
  • clinical hypertension
  • pediatric nephrology
  • pediatric intensive care medicine
  • epidemiology and outcomes
  • acute kidney injury

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