Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut2Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
Division of Pediatric Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
JAMA Pediatr. 2016 Nov 1;170(11):1071-1078. doi: 10.1001/jamapediatrics.2016.1532.
Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high short-term morbidity and mortality; however, the long-term kidney outcomes are unclear.
To assess long-term kidney outcomes after pediatric cardiac surgery and to determine if perioperative AKI is associated with worse long-term kidney outcomes.
DESIGN, SETTING, AND PARTICIPANTS: This prospective multicenter cohort study recruited children between ages 1 month to 18 years who underwent cardiopulmonary bypass for cardiac surgery and survived hospitalization from 3 North American pediatric centers between July 2007 and December 2009. Children were followed up with telephone calls and an in-person visit at 5 years after their surgery.
Acute kidney injury defined as a postoperative serum creatinine rise from preoperative baseline by 50% or 0.3 mg/dL or more during hospitalization for cardiac surgery.
Hypertension (blood pressure ≥95th percentile for height, age, sex, or self-reported hypertension), microalbuminuria (urine albumin to creatinine ratio >30 mg/g), and chronic kidney disease (serum creatinine estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 or microalbuminuria).
Overall, 131 children (median [interquartile range] age, 7.7 [5.9-9.9] years) participated in the 5-year in-person follow-up visit; 68 children (52%) were male. Fifty-seven of 131 children (44%) had postoperative AKI. At follow-up, 22 children (17%) had hypertension (10 times higher than the published general pediatric population prevalence), while 9 (8%), 13 (13%), and 1 (1%) had microalbuminuria, an eGFR less than 90 mL/min/1.73 m2, and an eGFR less than 60 mL/min/1.73 m2, respectively. Twenty-one children (18%) had chronic kidney disease. Only 5 children (4%) had been seen by a nephrologist during follow-up. There was no significant difference in renal outcomes between children with and without postoperative AKI.
Chronic kidney disease and hypertension are common 5 years after pediatric cardiac surgery. Perioperative AKI is not associated with these complications. Longer follow-up is needed to ascertain resolution or worsening of chronic kidney disease and hypertension.
儿科心脏手术后发生急性肾损伤（AKI）与短期高发病率和死亡率相关；然而，长期肾脏结局尚不清楚。
评估儿科心脏手术后的长期肾脏结局，并确定围手术期 AKI 是否与更差的长期肾脏结局相关。
设计、地点和参与者：本前瞻性多中心队列研究纳入了 2007 年 7 月至 2009 年 12 月期间在北美 3 家儿科中心接受体外循环心脏手术并存活出院的年龄在 1 个月至 18 岁之间的儿童。通过电话和手术 5 年后的亲自访视对儿童进行随访。
急性肾损伤定义为心脏手术后术后血清肌酐较术前基线升高 50%或 0.3mg/dL 或以上，或住院期间发生。
高血压（血压≥身高、年龄、性别或自我报告的高血压的第 95 百分位）、微量白蛋白尿（尿白蛋白与肌酐比值>30mg/g）和慢性肾脏病（血清肌酐估算肾小球滤过率[eGFR]<90mL/min/1.73m2或微量白蛋白尿）。
共有 131 名儿童（中位数[四分位距]年龄，7.7[5.9-9.9]岁）参加了 5 年的亲自随访；68 名儿童（52%）为男性。131 名儿童中有 57 名（44%）术后发生 AKI。随访时，22 名儿童（17%）患有高血压（是一般儿科人群患病率的 10 倍），9 名（8%）、13 名（13%）和 1 名（1%）儿童患有微量白蛋白尿、eGFR<90mL/min/1.73m2和 eGFR<60mL/min/1.73m2。21 名儿童（18%）患有慢性肾脏病。随访期间仅有 5 名儿童（4%）曾就诊于肾病科。术后 AKI 儿童与无术后 AKI 儿童的肾脏结局无显著差异。
儿科心脏手术后 5 年，慢性肾脏病和高血压很常见。围手术期 AKI 与这些并发症无关。需要更长时间的随访以确定慢性肾脏病和高血压的缓解或恶化情况。
