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Abstract: FR-PO1077

Association of Pediatric Cardiac Surgery-Associated AKI with 1- and 5-Year Healthcare Utilization and Kidney Outcomes

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Nunes, Sophia, Toronto Hospital for Sick Children, Toronto, Ontario, Canada
  • Hessey, Erin, University of Alberta Faculty of Medicine, Montreal, Alberta, Canada
  • Dorais, Marc, StatSciences Inc., Notre-Dame-de-l'Île-Perrot, Quebec, Canada
  • Zappitelli, Michael, Toronto Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Background

AKI in children undergoing cardiac surgery (CS) is strongly associated with hospital morbidity. Post-discharge CS AKI outcomes are less clear. Hypotheses: Pediatric CS AKI is associated with a) increased hospitalizations, emergency room (ER) visits and physician visits within 1 and 5 yrs post-discharge and b) increased risk for chronic kidney disease (CKD), hypertension (HTN) or death within 5 yrs post-discharge.

Methods

Retrospective 2-centre cohort study (children surviving to hospital discharge after CS, 2003-2005). Exposure: post-CS AKI (KDIGO serum creatinine and urine output definition). Outcomes: Number of hospitalizations, ER visits, and physician visits within 1 and 5 yrs of CS discharge; composite of CKD, HTN or death within 5 yrs of discharge. Multivariable Poisson regression: evaluate association of AKI with health care utilization; multivariable Cox-proportional hazards analysis: evaluate association of AKI with composite patient outcomes. Models adjusted for age and RACHS-1 score (surgical severity) ≥3.

Results

N=350 (age 3.1 ± 4.5 years; 180 [49%] AKI; 60 [17%] ≥Stage 2 AKI). See Table for detailed results: In adjusted analyses, AKI was associated with increased risk for 1-yr physician visits and 5-yr hospitalizations, ER visits and physician visits. 12.03% and 11.54% of AKI vs. non-AKI developed the composite patient outcome within 5 yrs of discharge. In adjusted analyses, AKI was not associated with CKD, HTN or death by 5 yrs post-discharge (Table).

Conclusion

Post-CS AKI is associated with higher 5-yr healthcare utilization, but not the composite outcome of CKD, HTN or death. Studies should aim to better understand post-CS surgery healthcare utilization patterns and non-AKI risk factors for CKD and HTN, to develop cost-effective strategies to reduce long-term CKD and HTN after CS.

Funding

  • Government Support - Non-U.S.