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Multicenter Study
. 2016 Nov 1;170(11):1071-1078.
doi: 10.1001/jamapediatrics.2016.1532.

Kidney Outcomes 5 Years After Pediatric Cardiac Surgery: The TRIBE-AKI Study

Jason H Greenberg  1 , Michael Zappitelli  2 , Prasad Devarajan  3 , Heather R Thiessen-Philbrook  4 , Catherine Krawczeski  5 , Simon Li  6 , Amit X Garg  7 , Steve Coca  8 , Chirag R Parikh  9 ; TRIBE-AKI Consortium
Affiliations
Multicenter Study

Kidney Outcomes 5 Years After Pediatric Cardiac Surgery: The TRIBE-AKI Study

Jason H Greenberg et al. JAMA Pediatr. .

Abstract

Importance: 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.

Objective: 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.

Exposures: 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.

Main outcomes and measures: 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).

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Devarajan reported being a coinventor on the neutrophil gelatinase–associated lipocalin patent. No other conflicts were reported.

Figures

Figure 1
Figure 1. TRIBE-AKI Study Population
Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) long-term follow-up cohort selection process.
Figure 2
Figure 2. Hypertension Prevalence Among Pediatric Center Cohorts Included in the TRIBE-AKI Study
Comparison of hypertension prevalence in 4 pediatric cohorts from the Translational Research Investigating Biomarker Endpoints in Acute Kidney Injury (TRIBE-AKI) pediatric cohort 5 years after cardiac surgery, the National Health and Nutrition Examination Survey (NHANES), the Kaiser Permanente health care system, and a large urban medical system in Northeast Ohio (eTable 3 in the Supplement). The NHANES, Kaiser, and Northeast Ohio cohorts were identified through a literature review.
See this image and copyright information in PMC

References

    1. Sutherland SM, Ji J, Sheikhi FH, et al. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013;8(10):1661–1669. - PMC - PubMed
    1. Devarajan P. Pediatric acute kidney injury: different from acute renal failure but how and why. Curr Pediatr Rep. 2013;1(1):34–40. - PMC - PubMed
    1. Li S, Krawczeski CD, Zappitelli M, et al. TRIBE-AKI Consortium Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39(6):1493–1499. - PMC - PubMed
    1. Morgan CJ, Zappitelli M, Robertson CM, et al. Western Canadian Complex Pediatric Therapies Follow-Up Group Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr. 2013;162(1):120–7.e1. - PubMed
    1. Kwiatkowski DM, Krawczeski CD. Acute kidney injury after cardiovascular surgery in children. In: Thakar CV, Parikh CR, editors. Perioperative Kidney Injury. New York: Springer; 2015. pp. 99–110.

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