Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T06:06:02.820Z Has data issue: false hasContentIssue false
  • English
  • Français

Paucity of renal follow-up by school age after neonatal cardiac surgery

Published online by Cambridge University Press:  19 May 2020

Sara Rodriguez-Lopez ,
Louis Huynh ,
Kelly Benisty ,
Adrian Dancea ,
Daniel Garros ,
Erin Hessey ,
Ari Joffe ,
Andrew Mackie ,
Ana Palijan  and
Alex Paun
...Show all authors
Sara Rodriguez-Lopez
Affiliation:
Department of Pediatrics, Division of Nephrology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
Louis Huynh
Affiliation:
Faculty of Health Sciences, School of Medicine, Queen’s University, Kingston, ON, Canada
Kelly Benisty
Affiliation:
Faculty of Medicine, McGill University, Montreal, QC, Canada
Adrian Dancea
Affiliation:
Department of Pediatrics, Division of Cardiology, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada
Daniel Garros
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
Erin Hessey
Affiliation:
Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
Ari Joffe
Affiliation:
Department of Pediatrics, Division of Pediatric Critical Care, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
Andrew Mackie
Affiliation:
Department of Pediatrics, Division of Cardiology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
Ana Palijan
Affiliation:
McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada
Alex Paun
Affiliation:
McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada
Michael Pizzi
Affiliation:
McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada
Teodora Riglea
Affiliation:
McGill University Health Centre Research Institute, McGill University Health Centre, Montreal, QC, Canada
Michael Zappitelli*
Affiliation:
Department of Pediatrics, Division of Nephrology, Toronto Hospital for Sick Children, Toronto, ON, Canada
Catherine Morgan*
Affiliation:
Department of Pediatrics, Division of Nephrology, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
*
Michael Zappitelli, MD, MSc, Toronto Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 6th floor 9708, Toronto, Ontario, Canada, M5G 0A4. Tel: +1 416 813 7654 extension 304077. E-mail: [email protected]
Author for correspondence: Catherine Morgan, MD, MSc, Edmonton Clinic Health Academy, Room 4-555, 11405-87 Avenue, Edmonton, Alberta, Canada, T6G 1C9. Tel: +1 780 248 5560. E-mail:[email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

There are little data about renal follow-up of neonates after cardiovascular surgery and no guidelines for long-term renal follow-up. Our objectives were to assess renal function follow-up practice after neonatal cardiac surgery, evaluate factors that predict follow-up serum creatinine measurements including acute kidney injury following surgery, and evaluate the estimated glomerular filtration rate during follow-up using routinely collected laboratory values.

Methods:

Two-centre retrospective cohort study of children 5–7 years of age with a history of neonatal cardiac surgery. Univariable and multivariable analyses were performed to determine factors associated with post-discharge creatinine measurements. Glomerular filtration rate was estimated for each creatinine using a height-independent equation.

Results:

Seventeen of 55 children (30%) did not have any creatinine measured following discharge after surgery until the end of study follow-up, which occurred at a median time of 6 years after discharge. Of the 38 children who had the kidney function checked, 15 (40%) had all of their creatinine drawn only in the context of a hospitalisation or emergency department visit. Acute kidney injury following surgery did not predict the presence of follow-up creatinine measurements.

Conclusions:

A large proportion of neonates undergoing congenital heart repair did not have a follow-up creatinine measured in the first years following surgery. In those that did have a creatinine measured, there did not appear to be any identified pattern of follow-up. A follow-up system for children who are discharged from cardiac surgery is needed to identify children with or at risk of chronic kidney disease.

Keywords

Neonatecardiac surgeryfollow-upserum creatinine
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 6 , June 2020 , pp. 822 - 828
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Luyckx, VA, Bertram, JF, Brenner, BM, et al.Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet. 2013;382(9888):273–83. doi: 10.1016/S0140-6736(13)60311-6CrossRefGoogle ScholarPubMed
Morgan, CJ, Zappitelli, M, Robertson, CM, et al.Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery. J Pediatr. 2013;162(1):120–27 e121. doi: 10.1016/j.jpeds.2012.06.054CrossRefGoogle ScholarPubMed
Lee, SH, Kim, SJ, Kim, HJ, Son, JS, Lee, R, Yoon, TG.Acute kidney injury following cardiopulmonary bypass in children- risk factors and outcomes. Circ J. 2017;81(10):1522–27. doi: 10.1253/circj.CJ-17-0075CrossRefGoogle ScholarPubMed
Alabbas, A, Campbell, A, Skippen, P, Human, D, Matsell, D, Mammen, C.Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study. Pediatr Nephrol. 2013;28(7):1127–34. doi: 10.1007/s00467-013-2454-3CrossRefGoogle ScholarPubMed
Li, S, Krawczeski, CD, Zappitelli, M, et al.Incidence, risk factors, and outcomes of acute kidney injury after pediatric cardiac surgery: a prospective multicenter study. Crit Care Med. 2011;39(6):1493–99. doi: 10.1097/CCM.0b013e31821201d3CrossRefGoogle ScholarPubMed
Blinder, JJ, Goldstein, SL, Lee, VV, et al.Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg. 2012;143(2):368–74. doi: 10.1016/j.jtcvs.2011.06.021CrossRefGoogle ScholarPubMed
Ishani, A, Nelson, D, Clothier, B, et al.The magnitude of acute serum creatinine increase after cardiac surgery and the risk of chronic kidney disease, progression of kidney disease, and death. Arch Intern Med. 2011;171(3):226–33. doi: 10.1001/archinternmed.2010.514CrossRefGoogle ScholarPubMed
Xu, JR, Zhu, JM, Jiang, J, et al.Risk factors for long-term mortality and progressive chronic kidney disease associated with acute kidney injury after cardiac surgery. Medicine (Baltimore) 2015;94(45):e2025. doi: 10.1097/MD.0000000000002025CrossRefGoogle ScholarPubMed
D’Hoore, E, Neirynck, N, Schepers, E, et al.Chronic kidney disease progression is mainly associated with non-recovery of acute kidney injury. J Nephrol. 2015;28(6):709–16. doi: 10.1007/s40620-015-0181-5CrossRefGoogle ScholarPubMed
Cooper, DS, Claes, D, Goldstein, SL, et al.Follow-up renal assessment of injury long-term after acute kidney injury (FRAIL-AKI). Clin J Am Soc Nephrol. 2016;11(1):21–9. doi: 10.2215/CJN.04240415CrossRefGoogle Scholar
Greenberg, JH, Zappitelli, M, Devarajan, P, et al.Kidney outcomes 5 years after pediatric cardiac surgery: the TRIBE-AKI study. JAMA Pediatr. 2016;170(11):1071–78. doi: 10.1001/jamapediatrics.2016.1532CrossRefGoogle ScholarPubMed
Madsen, NL, Goldstein, SL, Froslev, T, Christiansen, CF, Olsen, M.Cardiac surgery in patients with congenital heart disease is associated with acute kidney injury and the risk of chronic kidney disease. Kidney Int. 2017;92(3):751–56. doi: 10.1016/j.kint.2017.02.021CrossRefGoogle ScholarPubMed
Kent, AL, Charlton, JR, Guillet, R, et al.Neonatal acute kidney injury: a survey of neonatologists’ and nephrologists’ perceptions and practice management. Am J Perinatol. 2018;35(1):1–9. doi: 10.1055/s-0037-1604260Google ScholarPubMed
Jenkins, KJ, Gauvreau, K, Newburger, JW, Spray, TL, Moller, JH, Iezzoni, LI.Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg. 2002;123(1):110–18CrossRefGoogle ScholarPubMed
Pottel, H, Hoste, L, Martens, F.A simple height-independent equation for estimating glomerular filtration rate in children. Pediatr Nephrol. 2012;27(6):973–79. doi: 10.1007/s00467-011-2081-9CrossRefGoogle ScholarPubMed
KDIGO KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2012;3(1):19–28.Google Scholar
Schwartz, GJ, Work, DF.Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4(11):1832–43. doi: 10.2215/CJN.01640309CrossRefGoogle ScholarPubMed
Piepsz, A, Tondeur, M, Ham, H.Revisiting normal (51)Cr-ethylenediaminetetraacetic acid clearance values in children. Eur J Nucl Med Mol Imaging. 2006;33(12):1477–82. doi: 10.1007/s00259-006-0179-2CrossRefGoogle ScholarPubMed
Selewski, DT, Charlton, JR, Jetton, JG, et al.Neonatal acute kidney injury. Pediatrics. 2015;136(2):e463–73. doi: 10.1542/peds.2014-3819CrossRefGoogle ScholarPubMed
Askenazi, D, Abitbol, C, Boohaker, L, et al.Optimizing the AKI definition during first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort. Pediatr Res. 2019;85(3):329–38. doi: 10.1038/s41390-018-0249-8CrossRefGoogle ScholarPubMed
Jones, J, Holmen, J, De Graauw, J, Jovanovich, A, Thornton, S, Chonchol, M.Association of complete recovery from acute kidney injury with incident CKD stage 3 and all-cause mortality. Am J Kidney Dis. 2012;60(3):402–8. doi: 10.1053/j.ajkd.2012.03.014CrossRefGoogle ScholarPubMed
Pannu, N, James, M, Hemmelgarn, B, Klarenbach, S, Alberta Kidney Disease N. Association between AKI, recovery of renal function, and long-term outcomes after hospital discharge. Clin J Am Soc Nephrol. 2013;8(2):194–202. doi: 10.2215/CJN.06480612CrossRefGoogle ScholarPubMed
Hessey, E, Ali, R, Dorais, M, et al.Renal function follow-up and renal recovery after acute kidney injury in critically ill children. Pediatr Crit Care Med. 2017;18(8):733–40. doi: 10.1097/PCC.0000000000001166CrossRefGoogle ScholarPubMed