小儿心脏手术后急性肾损伤与慢性肾脏病和高血压的风险。
Acute Kidney Injury and Risk of CKD and Hypertension after Pediatric Cardiac Surgery.
机构信息
Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Nephrology, Department of Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
出版信息
Clin J Am Soc Nephrol. 2020 Oct 7;15(10):1403-1412. doi: 10.2215/CJN.00150120. Epub 2020 Sep 18.
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.
背景和目的
小儿心脏手术后急性肾损伤（AKI）与长期慢性肾脏病（CKD）和高血压发展的关联尚不清楚。本研究的目的是确定小儿心脏手术后 AKI 是否与新发 CKD 和高血压有关。
设计、地点、参与者和测量方法：这是一项前瞻性队列研究，纳入了在加拿大和美国两家三级保健中心接受心脏手术的 1 个月至 18 岁儿童。参与者在心脏手术前招募，并在住院期间以及出院后 3、12、24、36 和 48 个月进行随访。术后 AKI 是基于肾脏病改善全球结局（KDIGO）定义的暴露因素，手术时年龄＜2 岁是混杂因素。随访时的结局和测量指标为 CKD（按年龄计算的低肾小球滤过率或白蛋白尿）和高血压（根据 2017 年美国儿科学会指南），复合结局为 CKD 或高血压。
结果
在 124 名参与者中，57 名（46%）发生 AKI。AKI 组与非 AKI 组参与者的中位（四分位距）年龄分别为 8（4.8-40.8）岁和 46（6.0-158.4）岁，且术前 eGFR 更高。从 3 至 48 个月的随访中，队列的 CKD 患病率较高（17%-20%）；高血压的患病率也较高（22%-30%）。AKI 与整个随访期间 CKD 的发生无显著相关性。AKI 与出院后 12 个月时高血压的发生相关（校正相对风险，2.16；95%置信区间，1.18 至 3.95），但与随后的随访无关。手术时年龄＜2 岁的儿童在随访期间高血压的患病率明显高于年龄较大的儿童（3 个月随访时为 40%，48 个月随访时为 32%；21%，13%）。
结论
小儿心脏手术后 4 年内，CKD 和高血压的负担很高。手术时年龄较小，但不是 AKI，与它们的发生有关。
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