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Kidney Week

Abstract: TH-OR046

Kidney Biomarkers for CKD Risk Stratification after Pediatric Cardiac Surgery in the ASSESS-AKI Study

Session Information

Category: Pediatric Nephrology

  • 1600 Pediatric Nephrology

Authors

  • Greenberg, Jason Henry, Yale University , New Haven, Connecticut, United States
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  • Chinchilli, Vernon M., Penn State College of Medicine, Hershey, Pennsylvania, United States
  • Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States
  • Wurfel, Mark M., University of Washington, Seattle, Washington, United States
  • Siew, Edward D., Vanderbilt University School of Medicine, Nashville, Tennessee, United States
  • Go, Alan S., Kaiser Permanente Northern California, Oakland, California, United States
  • Kimmel, Paul L., National Institute of Diabetes and Digestive Kidney Diseases (NIDDK), Bethesda, Maryland, United States
  • Kaufman, James S., VA New York Harbor Healthcare System, New York, New York, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital, Cincinnati, Ohio, United States
  • Parikh, Chirag R., Yale University and VAMC, New Haven, Connecticut, United States

Group or Team Name

  • ASSESS-AKI
Background

We have previously demonstrated that children who require surgery for congenital heart disease have increased risk for long-term hypertension and chronic kidney disease (CKD). Biomarkers of ongoing kidney injury and fibrosis after surgery may indicate subclinical kidney disease and assist with prognosis for long-term hypertension and CKD.

Methods

We enrolled children from 1 month to 18 years old undergoing cardiac surgery in the ASSESS-AKI Study. We used Cox proportional hazards regression to assess the association between eight urinary biomarkers (log2 transformed) measured 3 months after cardiac surgery: NGAL, KIM-1, IL-18, L-FABP, uromodulin, MCP-1, YKL-40, and albumin, with the outcomes of incident hypertension (systolic or diastolic BP ≥ 95% for age, height, and gender) and CKD (modified Schwartz eGFR<90 ml/min/1.73m2) at yearly in-person visits over 4 years.

Results

117 children undergoing cardiac surgery were enrolled. During 48 months of follow-up there were 44 (38%) and 71 (61%) children who developed hypertension and CKD, respectively. After adjustment for sex, AKI during the index hospitalization for surgery, and pre-surgery eGFR, only urine albumin was independently associated with incident CKD (HR, 1.52; 95% CI, 1.20-1.93), but was not associated with incident hypertension (Table). None of the other 7 urinary biomarkers of injury or fibrosis were associated with either outcome.

Conclusion

At 3 months after cardiac surgery, children with higher urine albumin, but not any other tubular injury and fibrosis biomarkers, were more likely to develop CKD.

Funding

  • NIDDK Support