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



To assess long-term kidney outcomes after pediatric cardiac surgery and to determine if perioperative AKI is associated with worse long-term kidney outcomes.



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.



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.



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).



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.



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.
Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut2Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
Jason H
JH
Greenberg
Division of Pediatric Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada.
Michael
M
Zappitelli
Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Prasad
P
Devarajan
Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut.
Heather R
HR
Thiessen-Philbrook
Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
Catherine
C
Krawczeski
Division of Critical Care, Department of Pediatrics, Maria Fareri Children's Hospital, Valhalla, New York.
Simon
S
Li
Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada.
Amit X
AX
Garg
Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut8Section of Nephrology, Department of Internal Medicine, Mount Sinai School of Medicine, New York, New York.
Steve
S
Coca
Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut9Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut10VA Medical Center, West Haven, Connecticut.
Chirag R
CR
Parikh
D058186:Acute Kidney Injury / Q000097:blood / Q000209:etiology*; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis
D015415:Biomarkers; D003404:Creatinine