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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


  • 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


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.


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.


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.


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.


  • NIDDK Support