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Original Investigation
November 2016

Kidney Outcomes 5 Years After Pediatric Cardiac SurgeryThe TRIBE-AKI Study

Author Affiliations
  • 1Section of Nephrology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
  • 2Program of Applied Translational Research, Yale University School of Medicine, New Haven, Connecticut
  • 3Division of Pediatric Nephrology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
  • 4Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • 5Division of Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
  • 6Division of Critical Care, Department of Pediatrics, Maria Fareri Children’s Hospital, Valhalla, New York
  • 7Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
  • 8Section of Nephrology, Department of Internal Medicine, Mount Sinai School of Medicine, New York, New York
  • 9Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
  • 10VA Medical Center, West Haven, Connecticut
JAMA Pediatr. 2016;170(11):1071-1078. doi:10.1001/jamapediatrics.2016.1532
Key Points

Question  What are the 5-year kidney outcomes after pediatric cardiac surgery and is perioperative acute kidney injury a risk factor for worse outcomes?

Findings  Hypertension and chronic kidney disease were common 5 years after cardiac surgery. Acute kidney injury was not a risk factor for worse outcomes.

Meaning  These findings will provide data to begin making recommendations for renal follow-up after cardiac surgery in children.


Importance  Acute kidney injury (AKI) after pediatric cardiac surgery is associated with high short-term morbidity and mortality; however, the long-term kidney outcomes are unclear.

Objective  To assess long-term kidney outcomes after pediatric cardiac surgery and to determine if perioperative AKI is associated with worse long-term kidney outcomes.

Design, Setting, and Participants  This prospective multicenter cohort study recruited children between ages 1 month to 18 years who underwent cardiopulmonary bypass for cardiac surgery and survived hospitalization from 3 North American pediatric centers between July 2007 and December 2009. Children were followed up with telephone calls and an in-person visit at 5 years after their surgery.

Exposures  Acute kidney injury defined as a postoperative serum creatinine rise from preoperative baseline by 50% or 0.3 mg/dL or more during hospitalization for cardiac surgery.

Main Outcomes and Measures  Hypertension (blood pressure ≥95th percentile for height, age, sex, or self-reported hypertension), microalbuminuria (urine albumin to creatinine ratio >30 mg/g), and chronic kidney disease (serum creatinine estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 or microalbuminuria).

Results  Overall, 131 children (median [interquartile range] age, 7.7 [5.9-9.9] years) participated in the 5-year in-person follow-up visit; 68 children (52%) were male. Fifty-seven of 131 children (44%) had postoperative AKI. At follow-up, 22 children (17%) had hypertension (10 times higher than the published general pediatric population prevalence), while 9 (8%), 13 (13%), and 1 (1%) had microalbuminuria, an eGFR less than 90 mL/min/1.73 m2, and an eGFR less than 60 mL/min/1.73 m2, respectively. Twenty-one children (18%) had chronic kidney disease. Only 5 children (4%) had been seen by a nephrologist during follow-up. There was no significant difference in renal outcomes between children with and without postoperative AKI.

Conclusions and Relevance  Chronic kidney disease and hypertension are common 5 years after pediatric cardiac surgery. Perioperative AKI is not associated with these complications. Longer follow-up is needed to ascertain resolution or worsening of chronic kidney disease and hypertension.