Abstract: TH-OR046
Kidney Biomarkers for CKD Risk Stratification after Pediatric Cardiac Surgery in the ASSESS-AKI Study
Session Information
- Featured Research in Pediatric Nephrology
October 25, 2018 | Location: 26A, San Diego Convention Center
Abstract Time: 05:30 PM - 05:42 PM
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