Kidney Week

Abstract: FR-PO1143

Association of Body Mass Index with CKD and Hypertension 4 Years After Pediatric Cardiac Surgery

Session Information

• Pediatric Nephrology - I
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1600 Pediatric Nephrology

Authors

• Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

Michael Zappitelli,

• Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Chirag R. Parikh,

• Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States

Jason Henry Greenberg,

• Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States

Paul L. Kimmel,

• Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States

James S. Kaufman,

• Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States

Prasad Devarajan,

Group or Team Name

• ASSESS-AKI investigators

Background

We previously found that children undergoing cardiac surgery (CS) are at high risk of developing chronic kidney disease (CKD) and hypertension (HTN); however, CKD was not associated with post-operative (postop) acute kidney injury. Hypothesis: Body mass index (BMI) and peri-operative factors are associated with long-term CKD and HTN development after pediatric CS (PedCS).

Methods

Prospective cohort study (Montreal, Canada; Cincinnati, USA). Subjects: <18 years(y) old having CS, recruited pre-operatively (preop) followed postop and serially for 4y. At 4y, clinical data, height/weight, blood pressure (BP), blood and urine were collected. 4y outcomes: CKD (eGFR<90ml/min/1.73m²) or albumin-to-creatinine ratio≥3 mg/mmol; HTN: BP≥95^th percentile. Age at surgery <1y, RACHS-1 (surgical complexity score)≥3, preop eGFR, and 4y BMI z-score and overweight (OW, BMI≥85^th percentile), were compared between outcome groups. 4y BMI association with CKD (adjusted for perioperative factors) was evaluated using multiple logistic regression (LR).

Results

96/124 children had 4y data available: 24% had CKD; 13% had HTN; 22% were OW. Age<1y at surgery, RACHS-1≥3, smoking and OW were more common in CKD vs. no CKD patients(Table). No study variables were significantly associated with 4y HTN(Table). In multiple LR including age, RACHS-1 and preop eGFR, age<1y at surgery and each 10-unit decrease in preop eGFR were associated with a 5.9 (95% CI 1.8-18.6)-fold and 1.2 (95% CI 1.0-1.4)-fold adjusted risk for 4y CKD, respectively. When adjusted for age, RACHS-1 and preop eGFR, each 1 unit BMI z-score increase (at 4y) was associated with 1.5 (95% CI 1.0-2.2)-fold adjusted risk for 4y CKD. Sample size did not allow for LR analysis on HTN risk.

Conclusion

Young age at surgery and OW at follow-up are associated with CKD 4y after PedCS. Research is needed to understand the relation between young age and other risk factors for CKD development after PedCS. Post-PedCS interventions should aim to reduce long-term cardiovascular risk.

Funding

• NIDDK Support