Nakae Koji, Ueno Kentaro, Shiokawa Naohiro, Takahashi Yoshihiro, Kawamura Junpei, Hazeki Daisuke, Imoto Yutaka, Kawano Yoshifumi
Department of Pediatrics, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Department of Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
Pediatr Cardiol. 2022 Jun;43(5):1020-1028. doi: 10.1007/s00246-022-02817-z. Epub 2022 Jan 13.
Although the number of pediatric patients with long-term survival following cardiac surgery is increasing, concerns regarding chronic kidney disease (CKD) after surgery are growing. We examined the frequency of and risk factors for pediatric CKD development in patients with congenital heart disease (CHD) at least 2 years after cardiac surgery. This was a cross-sectional study of 147 patients who underwent open-heart surgery for CHD at Kagoshima University Hospital from April 2010 to March 2017. Data on demographics, acute kidney injury after cardiac surgery, cyanotic heart disease, Fontan circulation, medications in the perioperative period, and Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1) category were recorded. CKD was defined using the current classification system described in the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative and assessed during early childhood within 2-3 years of cardiac surgery. Statistical analyses were performed using SPSS Statistics for Windows version 25.0. We consecutively enrolled 147 patients, of whom 22 (15.0%) had CKD, all with stage-2 severity. Among patients with CKD, a higher proportion underwent Fontan surgery (P < 0.001), a higher proportion had cyanotic heart disease (P = 0.009), and the RACHS-1 category was high (P = 0.003). Patients with CKD appeared more frequently than patients without CKD in RACHS-1 categories 3, 5, and 6. It is essential to evaluate renal function longitudinally and monitor for CKD, given that patients who underwent Fontan surgery or complicated surgery in infancy have a high rate of developing postoperative CKD in early childhood.
尽管心脏手术后长期存活的儿科患者数量在增加，但对术后慢性肾脏病（CKD）的担忧也在加剧。我们研究了先天性心脏病（CHD）患者心脏手术后至少2年发生儿科CKD的频率及危险因素。这是一项对2010年4月至2017年3月在鹿儿岛大学医院接受CHD心脏直视手术的147例患者的横断面研究。记录了人口统计学数据、心脏手术后的急性肾损伤、青紫型心脏病、Fontan循环、围手术期用药以及先天性心脏病手术风险调整-1（RACHS-1）分类。CKD采用美国国家肾脏基金会的肾脏病预后质量倡议中描述的现行分类系统进行定义，并在心脏手术后2至3年的幼儿期进行评估。使用SPSS Statistics for Windows 25.0版进行统计分析。我们连续纳入了147例患者，其中22例（15.0%）患有CKD，均为2期严重程度。在患有CKD的患者中，接受Fontan手术的比例更高（P＜0.001），患有青紫型心脏病的比例更高（P = 0.009），且RACHS-1分类较高（P = 0.003）。在RACHS-1分类3、5和6中，患有CKD的患者比未患CKD的患者更频繁出现。鉴于婴儿期接受Fontan手术或复杂手术的患者在幼儿期发生术后CKD的几率很高，纵向评估肾功能并监测CKD至关重要。
