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Abstract: PO2326

Hypertension and CKD at 7 Years After Surgical Repair of Congenital Heart Disease in Children

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Greenberg, Jason Henry, Yale University, New Haven, Connecticut, United States
  • Zappitelli, Michael, Hospital for Sick Children, Toronto, Ontario, Canada
  • Thiessen Philbrook, Heather, Johns Hopkins University, Baltimore, Maryland, United States
  • Jia, Yaqi, Johns Hopkins University, Baltimore, Maryland, United States
  • Devarajan, Prasad, Cincinnati Children's Hospital Medical Center Division of Child and Adolescent Psychiatry, Cincinnati, Ohio, United States
  • Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Group or Team Name

  • TRIBE-AKI Consortium
Background

We previously determined that children who require surgery for congenital heart disease (CHD) are at an increased risk for hypertension and CKD 5 years after cardiac surgery. This study assessed the long-term risk of hypertension and CKD after cardiac surgery and if these outcomes are sustained.

Methods

We prospectively enrolled children from 1 month to 18 years old, undergoing cardiopulmonary bypass at three centers. Children who survived their surgical hospitalization had blood pressure, urine albumin to creatinine ratio, and serum creatinine measured at two in-person follow-up visits (median 5.4 years and 7.4 years after surgery). Hypertension was defined using the American Academy of Pediatrics 2017 Hypertension guidelines. Estimated GFR (eGFR) was calculated using the CKiD equation. CKD was defined as the presence of low eGFR (<90 ml/min/1.73m2) or microalbuminuria. We compared the risk of hypertension and CKD status at the 5 and 7-year visits using the McNemar test.

Results

Of 131 children with a follow-up visit 5 years after cardiac surgery, 88 (67%) children participated in the 7-year follow-up visit. The median age of the cohort at the 7-year follow-up was 10.7 [IQR: 7.8–13.0] years and 47% were female. 32 children had previously had a septal defect repair, 15 an inflow/outflow tract or valve procedure, 34 had a combined procedure, and 7 were not defined. Hypertension, microalbuminuria, eGFR<90, and eGFR<60 was 15%, 8%, 9%, and 1%, respectively, at the 5-year visit and 17%, 4%, 19%, and 1%, respectively, at the 7-year visit. CKD was present in 16% and 18% of children at the 5-year and 7-year visit, respectively, with no statistically significant change in risk at the two visits (p=0.35). Between the 5-year and 7-year visits, hypertension and CKD were sustained in 8 (62%) and 4 (29%) patients, respectively.

Conclusion

The long-term risk of hypertension and CKD were common at the 7-year visit. Compared to the five-year visit, hypertension was sustained in the majority of children. Although CKD was not sustained, there was an increased incidence of new children with GFR<90 at the 7-year visit. The risk factors for sustained hypertension and kidney disease should be further studied in children with congenital heart disease.

Funding

  • NIDDK Support