Seth A Hollander1, Maria E Montez-Rath2, David M Axelrod3, Catherine D Krawczeski3, Lindsay J May3, Katsuhide Maeda4, David N Rosenthal3, Scott M Sutherland5. 1. Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA. Electronic address: seth.hollander@stanford.edu. 2. Department of Nephrology, Stanford University School of Medicine, Palo Alto, CA. 3. Department of Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA. 4. Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, CA. 5. Department of Pediatrics (Nephrology), Stanford University School of Medicine, Palo Alto, CA.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common in children following surgery for congenital heart disease and has been associated with poor long-term kidney outcomes. Children undergoing heart transplantation may be at increased risk for the development of both AKI and chronic kidney disease (CKD). This study examines AKI rates in children, adolescents, and young adults after heart transplantation and analyzes the relationship between AKI and CKD in this population. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 88 young patients who underwent heart transplantation at Lucile Packard Children's Hospital, Stanford, CA, September 1, 2007, to November 30, 2013. PREDICTOR: The primary independent variable was AKI within the first 7 postoperative days, ascertained according to the KDIGO (Kidney Disease: Improving Global Outcomes) creatinine criteria (increase in serum creatinine ≥ 1.5 times baseline within 7 days). OUTCOMES: Recovery from AKI at 3 months, ascertained as serum creatinine level < 1.5 times baseline; and development of CKD at 6 and 12 months, ascertained as estimated glomerular filtration rate < 60mL/min/1.73m(2) for more than 3 months. RESULTS: 63 (72%) patients developed AKI; 57% had moderate (stage 2 or severe stage 3) disease. Recovery occurred in 39 of 63 (62%), 50% for stage 2 or 3 versus 78% for stage 1 (P=0.04). At 6 and 12 months, 3 of 82 (4%) and 4 of 76 (5%) developed CKD, respectively. At both time points, CKD was more common in those without recovery (3/22 [14%] vs 0/38 (0%); P=0.04, and 3/17 (18%) vs (0/34) 0%; P=0.03, respectively). LIMITATIONS: Retrospective design, small sample size, and single-center nature of the study. CONCLUSIONS: AKI is common after heart transplantation in children, adolescents, and young adults. Nonrecovery from AKI is more common in patients with more severe AKI and is associated with the development of CKD during the first year.
BACKGROUND:Acute kidney injury (AKI) is common in children following surgery for congenital heart disease and has been associated with poor long-term kidney outcomes. Children undergoing heart transplantation may be at increased risk for the development of both AKI and chronic kidney disease (CKD). This study examines AKI rates in children, adolescents, and young adults after heart transplantation and analyzes the relationship between AKI and CKD in this population. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 88 young patients who underwent heart transplantation at Lucile Packard Children's Hospital, Stanford, CA, September 1, 2007, to November 30, 2013. PREDICTOR: The primary independent variable was AKI within the first 7 postoperative days, ascertained according to the KDIGO (Kidney Disease: Improving Global Outcomes) creatinine criteria (increase in serum creatinine ≥ 1.5 times baseline within 7 days). OUTCOMES: Recovery from AKI at 3 months, ascertained as serum creatinine level < 1.5 times baseline; and development of CKD at 6 and 12 months, ascertained as estimated glomerular filtration rate < 60mL/min/1.73m(2) for more than 3 months. RESULTS: 63 (72%) patients developed AKI; 57% had moderate (stage 2 or severe stage 3) disease. Recovery occurred in 39 of 63 (62%), 50% for stage 2 or 3 versus 78% for stage 1 (P=0.04). At 6 and 12 months, 3 of 82 (4%) and 4 of 76 (5%) developed CKD, respectively. At both time points, CKD was more common in those without recovery (3/22 [14%] vs 0/38 (0%); P=0.04, and 3/17 (18%) vs (0/34) 0%; P=0.03, respectively). LIMITATIONS: Retrospective design, small sample size, and single-center nature of the study. CONCLUSIONS: AKI is common after heart transplantation in children, adolescents, and young adults. Nonrecovery from AKI is more common in patients with more severe AKI and is associated with the development of CKD during the first year.
Authors: Amanda M Uber; Maria E Montez-Rath; David M Kwiatkowski; Catherine D Krawczeski; Scott M Sutherland Journal: Pediatr Nephrol Date: 2018-07-09 Impact factor: 3.714
Authors: Erin Hessey; Geneviève Morissette; Jacques Lacroix; Sylvie Perreault; Susan Samuel; Marc Dorais; Véronique Phan; Philippe Jouvet; Jean-Philippe Lafrance; Jacques LeLorier; Ana Palijan; Michael Pizzi; Louise Roy; Michael Zappitelli Journal: Clin J Am Soc Nephrol Date: 2018-04-20 Impact factor: 8.237
Authors: Mital Patel; Anna Heipertz; Emily Joyce; John A Kellum; Christopher Horvat; James E Squires; Shawn C West; Priyanka Priyanka; Dana Y Fuhrman Journal: Pediatr Transplant Date: 2021-10-20
Authors: Michael LoBasso; James Schneider; L Nelson Sanchez-Pinto; Sylvia Del Castillo; Gina Kim; Alysia Flynn; Christine B Sethna Journal: Pediatr Nephrol Date: 2021-08-12 Impact factor: 3.714
Authors: Cal H Robinson; Nivethika Jeyakumar; Bin Luo; Ron Wald; Amit X Garg; Danielle M Nash; Eric McArthur; Jason H Greenberg; David Askenazi; Cherry Mammen; Lehana Thabane; Stuart Goldstein; Rulan S Parekh; Michael Zappitelli; Rahul Chanchlani Journal: J Am Soc Nephrol Date: 2021-05-26 Impact factor: 14.978
Authors: Anthony Batte; Zachary Berrens; Kristin Murphy; Ivan Mufumba; Maithri L Sarangam; Michael T Hawkes; Andrea L Conroy Journal: Int J Nephrol Renovasc Dis Date: 2021-07-08