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Children who have congenital heart disease surgery found at high risk for mortality, ESKD
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Researchers of a published study found that, after cardiac surgery, children with congenital heart disease had an increased risk for both ESKD and mortality.
“There is emerging evidence suggesting that pathologic changes occur after surgical repair of congenital heart disease not only in the cardiovascular system but also in the kidneys,” Chirag R. Parikh, MBBS, PhD, of Johns Hopkins University, and colleagues wrote. “Understanding the natural history of ESKD and death after childhood cardiac surgery informs the need to prevent and treat kidney disease in an at-risk population.”
Researchers conducted a retrospective cohort study of 3,600 children with congenital heart disease who had their first cardiac surgery within 10 years of birth (median age at first surgery, 150 days). Each participant was matched to 10 children who did not have congenital heart disease, but who were similar in age, sex, rurality and neighborhood income. Patients were followed for a median of 5.9 years after surgical repair. During this time, 4% died and 1% reached ESKD.
Researchers found the cumulative incidence of death was higher in children who had surgical repair for congenital heart disease at 1, 5, and 10 years compared with the control population (3% vs. 0.06%, 4% vs. 0.10% and 5% vs. 0.13%, respectively). ESKD incidence was also higher for those who underwent surgical repair at each time point (1 year: 1% vs. 0%; 5 years: 2% vs. 0.02%; 10 years: 2% vs. 0.02%).
Researchers noted the risk for ESKD and death increased with severity of congenital heart disease and was highest in children with hypoplastic left heart syndrome.
“Our findings highlight the importance of monitoring for long-term kidney dysfunction after cardiac surgery,” they wrote. “Kidney follow-up after congenital heart disease surgery should include monitoring kidney function, avoiding nephrotoxins, and treating hypertension and proteinuria to limit the progression of kidney disease. The risk of ESKD and mortality was highest in the first year after surgery, which highlights the importance of closer outpatient follow-up after surgery and new risk stratification approaches to identify those children at highest risk.” – by Melissa J. Webb
Disclosures: Parikh reports receiving personal fees from Akebia Therapeutics Inc., Genfit Biopharmaceutical Company and Renaltix AI. Please see the study for all other authors’ relevant financial disclosures.
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