Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MA; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Faculty of Medicine, Radboud University, Nijmegen, The Netherlands; Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.
J Pediatr. 2023 Jan;252:83-92.e5. doi: 10.1016/j.jpeds.2022.09.005. Epub 2022 Sep 9.
The objective of this study was to evaluate the available data on long-term kidney dysfunction, hypertension, and mortality after cardiac surgery-associated acute kidney injury (AKI) in the pediatric population.
PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for eligible studies published from inception through March 2022. Long-term outcomes after pediatric cardiac surgery complicated by AKI and those without were investigated.
We identified 14 studies published between 2013 and 2022 that included a total of 6701 patients (AKI: 1376 patients; no AKI: 5325 patients). These studies used different well-established classifications to define AKI. All the studies suggested that AKI after heart surgery is common in the pediatric patient population and reported a potential link between cardiac surgery-associated AKI and important clinical outcomes. However, only 4 out of 11 studies found a strong association between (absence of recovery from) cardiac surgery-associated AKI and risk of developing chronic kidney disease, and 3 out of 5 studies found a significant increase in mortality rates for pediatric patients who developed AKI after cardiac surgery. Only 1 out of 4 studies found an association between AKI and hypertension at 12 months postoperatively, but found no association at later follow-up times.
Although there is a trend, evidence on the long-term consequences of cardiac surgery-associated AKI in the pediatric population is mixed. Genetic syndromes, preexisting kidney disease, univentricular or cyanotic heart conditions, and/or high-complexity surgery may be more important for the development of kidney dysfunction by adolescence and early adulthood. Regardless, these children may benefit from a long-term kidney follow-up.
本研究旨在评估儿科心脏手术相关急性肾损伤（AKI）后长期肾功能障碍、高血压和死亡率的可用数据。
通过 PubMed/MEDLINE、Embase、Scopus 和相关文章的参考文献列表，检索了截至 2022 年 3 月发表的合格研究。调查了儿科心脏手术后并发 AKI 和无 AKI 的患者的长期预后。
我们确定了 2013 年至 2022 年期间发表的 14 项研究，这些研究共纳入了 6701 名患者（AKI：1376 名患者；无 AKI：5325 名患者）。这些研究使用了不同的成熟分类方法来定义 AKI。所有研究均表明，心脏手术后 AKI 在儿科患者中很常见，并报告了心脏手术相关 AKI 与重要临床结局之间的潜在联系。然而，仅有 4 项研究中的 11 项发现心脏手术相关 AKI（无恢复）与发生慢性肾脏病的风险之间存在强烈关联，5 项研究中的 3 项发现心脏手术后发生 AKI 的儿科患者死亡率显著升高。仅有 4 项研究中的 1 项发现 AKI 与术后 12 个月的高血压之间存在关联，但在随后的随访时间中没有发现关联。
尽管有趋势，但儿科人群中心脏手术相关 AKI 的长期后果的证据存在分歧。遗传综合征、预先存在的肾脏疾病、单心室或发绀性心脏疾病和/或高复杂性手术可能更重要，可导致青少年和成年早期的肾功能障碍。无论如何，这些儿童可能受益于长期肾脏随访。
