Michael Zappitelli1, Chirag R Parikh2, James S Kaufman3, Alan S Go4,5, Paul L Kimmel6, Chi-Yuan Hsu4,5, Steven G Coca7, Vernon M Chinchilli8, Jason H Greenberg9, Marva M Moxey-Mims10, T Alp Ikizler11,12,13, Vedran Cockovski14, Anne-Marie Dyer8, Prasad Devarajan15. 1. Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada Michael.zappitelli@sickkids.ca Prasad.devarajan@cchmc.org. 2. Division of Nephrology, Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland. 3. Veterans Affairs New York Harbor Healthcare System, New York University School of Medicine, New York, New York. 4. Division of Research, Kaiser Permanente Northern California, Oakland, California. 5. Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California. 6. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland. 7. Division of Nephrology, Department of Medicine, Icahn School of Medicine, Mount Sinai, New York. 8. Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania. 9. Division of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut. 10. Division of Nephrology, Children's National Hospital, Washington, DC. 11. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. 12. Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Veteran's Health Administration, Nashville, Tennessee. 13. Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee. 14. Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. 15. Department of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio Michael.zappitelli@sickkids.ca Prasad.devarajan@cchmc.org.
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.
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.
Authors: Bo Xi; Tao Zhang; Meixian Zhang; Fangchao Liu; Xinnan Zong; Min Zhao; Youfa Wang Journal: Am J Hypertens Date: 2015-07-08 Impact factor: 2.689
Authors: Chi-yuan Hsu; Raymond K Hsu; Jingrong Yang; Juan D Ordonez; Sijie Zheng; Alan S Go Journal: J Am Soc Nephrol Date: 2015-07-01 Impact factor: 10.121
Authors: Michael Zappitelli; Namasivayam Ambalavanan; David J Askenazi; Marva M Moxey-Mims; Paul L Kimmel; Robert A Star; Carolyn L Abitbol; Patrick D Brophy; Guillermo Hidalgo; Mina Hanna; Catherine M Morgan; Tonse N K Raju; Patricio Ray; Zayhara Reyes-Bou; Amani Roushdi; Stuart L Goldstein Journal: Pediatr Res Date: 2017-07-11 Impact factor: 3.756
Authors: Joseph T Flynn; David C Kaelber; Carissa M Baker-Smith; Douglas Blowey; Aaron E Carroll; Stephen R Daniels; Sarah D de Ferranti; Janis M Dionne; Bonita Falkner; Susan K Flinn; Samuel S Gidding; Celeste Goodwin; Michael G Leu; Makia E Powers; Corinna Rea; Joshua Samuels; Madeline Simasek; Vidhu V Thaker; Elaine M Urbina Journal: Pediatrics Date: 2017-08-21 Impact factor: 7.124
Authors: Michael Heung; Diane E Steffick; Kara Zivin; Brenda W Gillespie; Tanushree Banerjee; Chi-Yuan Hsu; Neil R Powe; Meda E Pavkov; Desmond E Williams; Rajiv Saran; Vahakn B Shahinian Journal: Am J Kidney Dis Date: 2015-12-12 Impact factor: 8.860
Authors: Jason H Greenberg; Michael Zappitelli; Prasad Devarajan; Heather R Thiessen-Philbrook; Catherine Krawczeski; Simon Li; Amit X Garg; Steve Coca; Chirag R Parikh Journal: JAMA Pediatr Date: 2016-11-01 Impact factor: 16.193
Authors: Omar Alkandari; K Allen Eddington; Ayaz Hyder; France Gauvin; Thierry Ducruet; Ronald Gottesman; Véronique Phan; Michael Zappitelli Journal: Crit Care Date: 2011-06-10 Impact factor: 9.097
Authors: Cal H Robinson; Nivethika Jeyakumar; Ron Wald; Michael Zappitelli; Rahul Chanchlani Journal: J Am Soc Nephrol Date: 2021-09-16 Impact factor: 14.978
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: Erin Hessey; Nabil Melhem; Rashid Alobaidi; Emma Ulrich; Catherine Morgan; Sean M Bagshaw; Manish D Sinha Journal: Front Pediatr Date: 2021-03-15 Impact factor: 3.418