Follow-up after neonatal heart disease repair: watch out for chronic kidney disease and hypertension!,Pediatric Nephrology

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Follow-up after neonatal heart disease repair: watch out for chronic kidney disease and hypertension!
Pediatric Nephrology ( IF 3 ) Pub Date : 2020-06-04 , DOI: 10.1007/s00467-020-04621-4
Louis Huynh ₁ , Sara Rodriguez-Lopez ₂ , Kelly Benisty ₃ , Adrian Dancea ₄ , Daniel Garros ₅ , Erin Hessey ₆ , Ari Joffe ₅ , Rachel Joffe ₆ , Andrew Mackie ₇ , Ana Palijan ₈ , Alex Paun ₈ , Michael Pizzi ₈ , Michael Zappitelli ₉ , Catherine Morgan ₂

Affiliation

Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada.
Department of Pediatrics, Division of Nephrology, University of Alberta, Stollery Children's Hospital, Room 4-555, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
Faculty of Medicine, McGill University, Montreal, QC, Canada.
Department of Pediatrics, Division of Cardiology, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
Department of Pediatrics, Division of Pediatric Critical Care, University of Alberta, Edmonton, AB, Canada.
Faculty of Medicine, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, Division of Cardiology, University of Alberta, Edmonton, AB, Canada.
McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada.
Department of Pediatrics, Division of Nephrology, Peter Gilgan Centre for Research and Learning, Toronto Hospital for Sick Children, 686 Bay Street, Room 6th floor 9708, Toronto, ON, M5G 0A4, Canada.

Background

With 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.

Methods

Two-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.

Results

Fifty-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.

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. 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.

中文翻译：

新生儿心脏病修复后的随访：注意慢性肾脏病和高血压！

背景

随着护理的进步，接受心脏修复的新生儿的存活率更高。我们的目标是：1）评估新生儿先天性心脏手术后6年的慢性肾脏病（CKD）和高血压的患病率，以及2）确定心脏手术相关的急性肾损伤（CS-AKI）是否与这些结果相关。

方法

2005年1月至2012年12月间进行的两中心前瞻性，纵向单次就诊队列研究，包括患有先天性心脏病手术的婴儿（新生儿）。CKD（估计肾小球滤过率<90 mL / min / 1.73m ²或白蛋白/肌酐≥3mg /估计术后6年高血压和高血压（年龄，性别和身高的收缩压或舒张压≥95％）的患病率。使用多元回归分析确定CS-AKI（肾脏疾病：改善总体结局定义）与CKD和高血压的相关性。