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：

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新生儿心脏病修复后随访：警惕慢性肾病、高血压！

 背景

随着护理技术的进步，接受心脏修复手术的新生儿存活率越来越高。我们的目标是 1) 估计新生儿先天性心脏手术后 6 年慢性肾脏病 (CKD) 和高血压的患病率，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

两中心前瞻性、纵向单次队列研究，纳入 2005 年 1 月至 2012 年 12 月期间接受先天性心脏病手术的新生儿。CKD（估计肾小球滤过率 < 90 mL/min/1.73m ²或白蛋白/肌酐≥3 mg/估计手术后 6 年的高血压（收缩压或舒张压≥年龄、性别和身高的第 95 个百分位）患病率。使用多元回归确定 CS-AKI（肾脏疾病：改善全球结果定义）与 CKD 和高血压的关联。

 结果

对 58 名中位随访时间为 6 年的儿童进行了评估。 CS-AKI 发生率为 58%。 CKD 和高血压患病率分别为 17% 和 30%；另外 15% 被归类为血压升高。 CS-AKI 与 CKD 或高血压无关。术后紫绀分类是 CKD 的唯一独立预测因素。术后住院天数预测随访时出现高血压。

 结论

接受新生儿先天性心脏病手术的儿童中 CKD 和高血压的患病率很高。这很重要；早期识别 CKD 和高血压可以改善预后。应系统地跟踪这些儿童，了解这些负面结果的演变。当前标准定义的 CS-AKI 可能不是决定谁需要随访、谁不需要随访的有用临床工具。