Kidney injury biomarkers 5 years after AKI due to pediatric cardiac surgery

Pediatr Nephrol. 2018 Jun;33(6):1069-1077. doi: 10.1007/s00467-018-3888-4. Epub 2018 Mar 6.

Abstract

Background: We previously reported that children undergoing cardiac surgery are at high risk for long-term chronic kidney disease (CKD) and hypertension, although postoperative acute kidney injury (AKI) is not a risk factor for worse long-term kidney outcomes. We report here our evaluation of renal injury biomarkers 5 years after cardiac surgery to determine whether they are associated with postoperative AKI or long-term CKD and hypertension.

Methods: Children aged 1 month to 18 years old undergoing cardiopulmonary bypass were recruited to this prospective cohort study. At 5 years after cardiac surgery, we measured urine interleukin-18, kidney injury molecule-1, monocyte chemoattractant protein-1, YKL-40, and neutrophil gelatinase-associated lipocalin (NGAL). Biomarker levels were compared between patients with AKI and those without. We also performed a cross-sectional analysis of the association between these biomarkers with CKD and hypertension.

Results: Of the 305 subjects who survived hospitalization, four (1.3%) died after discharge, and 110 (36%) participated in the 5-year follow-up. Of these 110 patients, 49 (45%) had AKI. Patients with versus those without postoperative AKI did not have significantly different biomarker concentrations at 5 years after cardiac surgery. None of the biomarker concentrations were associated with CKD or hypertension at 5 years of follow-up, although CKD and hypertension were associated with a higher proportion of participants with abnormal NGAL levels.

Conclusions: Postoperative pediatric AKI is not associated with urinary kidney injury biomarkers 5 years after surgery. This may represent a lack of chronic renal injury after AKI, imprecise estimation of the glomerular filtration rate, the need for longer follow-up to detect chronic renal damage, or that our studied biomarkers are inadequate for evaluating subclinical chronic renal injury.

Keywords: Acute kidney injury; Biomarker; CKD; Cardiopulmonary bypass; Children; Long-term outcomes.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Kidney Injury / complications
  • Acute Kidney Injury / urine*
  • Adolescent
  • Biomarkers / urine*
  • Cardiopulmonary Bypass / adverse effects*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Heart Defects, Congenital / surgery
  • Humans
  • Hypertension / epidemiology
  • Hypertension / etiology
  • Hypertension / urine
  • Infant
  • Kidney / physiopathology
  • Male
  • Postoperative Complications / urine*
  • Prospective Studies
  • Renal Insufficiency, Chronic / epidemiology
  • Renal Insufficiency, Chronic / etiology
  • Renal Insufficiency, Chronic / urine

Substances

  • Biomarkers