Abstract: SA-OR044

Long-Term Renal Outcomes in Children Who Had Surgical Repair of Congenital Heart Disease

Session Information

Category: Developmental Biology and Inherited Kidney Diseases

  • 403 Pediatric Nephrology

Authors

  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States
  • Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
  • McArthur, Eric, Institute for Clinical Evaluative Sciences, London, Ontario, Canada
  • Thiessen Philbrook, Heather, Yale University, New Haven, Connecticut, United States
  • Wald, Ron, St. Michael's Hospital, Toronto, Ontario, Canada
  • Zappitelli, Michael, McGill University Health Centre, Montreal Children's Hospital, Montreal, Quebec, Canada
  • Chanchlani, Rahul, None, Hamilton, Ontario, Canada
  • Garg, Amit X., London Health Sciences Centre, London, Ontario, Canada
Background

The risk of mortality in children who require surgery for congenital heart disease (S-CHD) has markedly reduced in recent years due to advances in pediatric and surgical care. However, there are limited data on long-term kidney outcomes in children after S-CHD compared with the general population of children.

Methods

A registry-based, matched-cohort study was conducted across 7 administrative Canadian databases. Children were included if they were born between April 1, 2002 and March 31, 2015 and underwent surgery for CHD. Follow-up and comorbidity data were collected until March 2015. Children serving as controls (10 controls for each patient with S-CHD), were matched for age, sex, neighborhood income quintile, and county, and were randomly selected from the general population. Survival analyses were performed with Cox proportional hazards models.

Results

Of the 3600 patients with a diagnosis of S-CHD, 1595 were female (44.3%). Median age at first surgery was 150 (IQR, 40-252) days and 21.8% of the children were low birthweight (<2500 grams). The median (IQR) follow-up time was 5.9 (2.9-9.0) years. 52 (1.4%) children reached ESRD in follow-up. The 10-year cumulative incidences of hypertension and CKD were 12.9% and 2.1%, respectively. The hazard ratios for renal outcomes and mortality in children with S-CHD compared with controls were significantly higher (Table). According to RACHS-1 severity classifications, the group of patients with the most severe complex defects (RACHS-1 category 4) had the highest risk for death and renal outcomes. Trends in relative increase in risk of renal outcomes and mortality were also seen associated with younger age at surgery (<150 days), but not with income quintile or preterm status at birth.

Conclusion

Despite dramatic recent improvements in outcomes after S-CHD, the incidence of long-term hypertension, CKD, ESRD and mortality remains high in these patients compared to matched controls. Further interventions aimed at improving renal outcomes in this vulnerable group are required.

Funding

  • NIDDK Support