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Kidney Week

Abstract: FR-PO1086

Long-Term Renal Outcomes in Children with AKI Post Cardiac Surgery

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Radhakrishnan, Yeshwanter, Cleveland Clinic Akron General, Akron, Ohio, United States
  • Raina, Rupesh, Cleveland Clinic Akron General, Akron, Ohio, United States
  • Sethi, Sidharth Kumar, Medanta, The Medicity Hospital, Gurgaon, India
Background

Acute Kidney Injury (AKI) is associated with poor short-term outcomes such as mortality, longer ICU and hospital length of stay and duration of mechanical ventilation as demonstrated by numerous studies. Our objective was to study the long-term renal outcomes and markers of kidney injury in pediatric patients with congenital heart disease who did and did not develop AKI following cardiac bypass surgery.

Methods

This was a prospective case-control observational study in which all infants and children who underwent cardiac bypass surgery from 2010-2017 and who had a long term follow up were included. Patients with CKD, Hypertension, AKI from primary kidney disease and previous history of AKI were excluded. 44 Patients who developed AKI were matched to 49 consecutive controls who did not develop AKI postoperatively. GFR was estimated by Schwartz formula and cystatin C. Kidney injury biomarkers that were used are NGAL, L-FABO, KIM-1, IL18.

Results

Age, Gender, weight, height, aortic cross-clamp (ACC) time and cardiopulmonary bypass (CPB) time were not statistically significant among cases and controls. Patients with AKI had a higher baseline serum creatinine (0.43±0.22, p<0.001) and longer ICU length of stay (days, 5.7±3.0, p<0.001) than the control group. On the long term follow up, patients with AKI had a higher serum creatinine level, the trend towards higher urinary KIM-1 levels and lower estimated GFR but were not statistically significant. When backward linear regression analysis was performed, CPB time (Odds Ratio: -0.550, p<0.05) and AKI (OR: 10.913, p>0.05) were the only risk factors associated with lower GFR at follow-up. CPB time (OR: 0.010, p<0.05), baseline serum creatinine (OR: -0.643, p>0.050) and AKI (OR: -0.381, p<0.05) were the only risk factors associated with higher KIM-1 at follow up.

Conclusion

Cardiopulmonary bypass time (CPB) is significantly associated with a decrease in GFR and a rise in kidney injury biomarker KIM-1 level several months post postoperatively independent of postoperative AKI.