Dasgupta Minnie N, Montez-Rath Maria E, Hollander Seth A, Sutherland Scott M
Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
Department of Nephrology, Stanford University, Palo Alto, CA, USA.
Pediatr Res. 2021 Sep;90(3):632-636. doi: 10.1038/s41390-020-01307-3. Epub 2021 Jan 14.
Acute kidney injury (AKI) is common following pediatric cardiac transplantation. Since no treatments exist, strategies focus on early identification and prevention. Kinetic glomerular filtration rate (kGFR) was developed to assess renal function in the non-steady state. Although used to predict AKI in adults, kGFR has not been explored in children. Our study examines AKI and the ability of kGFR to identify AKI risk in pediatric heart transplant recipients.
One hundred and seventy-five patients under 21 years who underwent cardiac transplantation at Lucile Packard Children's Hospital between September 2007-December 2017 were included. kGFR was calculated using pre-operative and immediate post-operative creatinines; kGFR was calculated with the first two post-operative creatinines. The primary outcome was AKI as defined by the Kidney Disease: Improving Global Outcomes criteria.
One hundred and thirty-one (75%) and 78 (45%) patients developed AKI and severe AKI, respectively; 5 (2.9%) required dialysis. kGFR was moderately associated with post-operative AKI risk. The adjusted area under the curve (AUC) for kGFR was 0.72 (discovery) and 0.65 (validation). The AUC for kGFR was 0.72 (discovery) and 0.68 (validation).
AKI is pervasive in children undergoing cardiac transplant, particularly in the 24 h after surgery. kGFR moderately identifies AKI risk and may represent a novel risk stratification technique.
Our research suggests that kGFR, a dynamic assessment of renal function that uses readily available laboratory values, can moderately identify AKI risk in children undergoing cardiac transplantation. Current published studies on kGFR are in adult populations; this study represents the first formal study of kGFR in a pediatric population. kGFR may serve as an early AKI indicator, allowing providers to implement preventative strategies sooner in a patient's clinical course.
急性肾损伤（AKI）在小儿心脏移植术后很常见。由于尚无治疗方法，策略重点在于早期识别和预防。动态肾小球滤过率（kGFR）被开发用于评估非稳态下的肾功能。尽管kGFR已用于预测成人的AKI，但尚未在儿童中进行研究。我们的研究探讨了小儿心脏移植受者中的AKI以及kGFR识别AKI风险的能力。
纳入2007年9月至2017年12月在露西尔·帕卡德儿童医院接受心脏移植的175例21岁以下患者。使用术前和术后即刻的肌酐计算kGFR；用术后前两个肌酐计算kGFR。主要结局是根据改善全球肾脏病预后组织（KDIGO）标准定义的AKI。
分别有131例（75%）和78例（45%）患者发生AKI和严重AKI；5例（2.9%）需要透析。kGFR与术后AKI风险中度相关。kGFR的校正曲线下面积（AUC）在发现队列中为0.72，在验证队列中为0.65。kGFR的AUC在发现队列中为0.72，在验证队列中为0.68。
AKI在接受心脏移植的儿童中普遍存在，尤其是在术后24小时内。kGFR能中度识别AKI风险，可能代表一种新的风险分层技术。
我们的研究表明，kGFR作为一种利用现成实验室值对肾功能进行的动态评估，能够中度识别接受心脏移植儿童的AKI风险。目前已发表的关于kGFR的研究针对的是成人人群；本研究是kGFR在儿科人群中的首次正式研究。kGFR可作为早期AKI指标，使医疗人员能够在患者临床病程中更早地实施预防策略。
