Biomarkers of eGFR decline after cardiac surgery in children: findings from the ASSESS-AKI study.
Pediatr Nephrol
; 38(8): 2851-2860, 2023 08.
Article
em En
| MEDLINE
| ID: mdl-36790467
ABSTRACT
BACKGROUND:
Children who require surgery for congenital heart disease have increased risk for long-term chronic kidney disease (CKD). Clinical factors as well as urine biomarkers of tubular health and injury may help improve the prognostication of estimated glomerular filtration rate (eGFR) decline.METHODS:
We enrolled children from 1 month to 18 years old undergoing cardiac surgery in the ASSESS-AKI cohort. We used mixed-effect models to assess the association between urinary biomarkers (log2-transformed uromodulin, NGAL, KIM-1, IL-18, L-FABP) measured 3 months after cardiac surgery and cyanotic heart disease with the rate of eGFR decline at annual in-person visits over 4 years.RESULTS:
Of the 117 children enrolled, 30 (24%) had cyanotic heart disease. During 48 months of follow-up, the median eGFR in the subgroup of children with cyanotic heart disease was lower at all study visits as compared with children with acyanotic heart disease (p = 0.01). In the overall cohort, lower levels of both urine uromodulin and IL-18 after discharge were associated with eGFR decline. After adjustment for age, RACHS-1 surgical complexity score, proteinuria, and eGFR at the 3-month study visit, lower concentrations of urine uromodulin and IL-18 were associated with a monthly decline in eGFR (uromodulin ß = 0.04 (95% CI 0.00-0.09; p = 0.07) IL-18 ß = 0.07 (95% CI 0.01-0.13; p = 0.04), ml/min/1.73 m2 per month).CONCLUSIONS:
At 3 months after cardiac surgery, children with lower urine uromodulin and IL-18 concentrations experienced a significantly faster decline in eGFR. Children with cyanotic heart disease had a lower median eGFR at all time points but did not experience faster eGFR decline. A higher-resolution version of the Graphical abstract is available as Supplementary information.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Insuficiência Renal Crônica
/
Injúria Renal Aguda
/
Cardiopatias Congênitas
/
Procedimentos Cirúrgicos Cardíacos
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
Limite:
Child
/
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article