Biomarkers of eGFR decline after cardiac surgery in children: findings from the ASSESS-AKI study.
Biomarkers of eGFR decline after cardiac surgery in children: findings from the ASSESS-AKI study.
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儿童心脏手术后 eGFR 生物标志物下降：ASSESS-AKI 研究的结果。
DOI：
10.1007/s00467-023-05886-1
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Greenberg,JasonH
中科院分区：
文献类型：
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作者：
deFontnouvelle,Christina;Zappitelli,Michael;Thiessen-Philbrook,HeatherR;Jia,Yaqi;Kimmel,PaulL;Kaufman,JamesS;Devarajan,Prasad;Parikh,ChiragR;Greenberg,JasonH
研究背景先天性心脏病需要手术治疗的儿童患慢性肾脏病（CKD）的风险增加。临床因素以及肾小管健康和损伤的尿生物标志物可能有助于改善估计肾小球滤过率（eGFR）decline.MethodsWe招募1个月至18岁的儿童接受心脏手术的评估-AKI队列的classification。我们使用混合效应模型来评估尿生物标志物（log 2转换尿调素，NGAL，KIM-1，IL-18，L-FABP）之间的关联测量3个月后心脏手术和紫绀型心脏病与eGFR下降率在每年的人超过4 years.ResultsOf 117名儿童入组，30（24%）有紫绀型心脏病。在48个月的随访中，紫绀型心脏病儿童亚组的中位eGFR在所有研究访视时均低于非紫绀型心脏病儿童（p= 0.01）。在整个队列中，出院后尿尿调蛋白和IL-18水平降低与eGFR下降相关。在对年龄、RACHS-1手术复杂性评分、蛋白尿和3个月研究访视时的eGFR进行校正后，尿尿调节素和IL-18浓度较低与eGFR每月下降相关（尿调素β = 0.04（95% CI：0.00-0.09;p= 0.07））IL-18 β = 0.07（95% CI：0.01-0.13; p= 0.04），ml/min/1.73 m2每月）。结论心脏手术后3个月，尿尿调素和IL-18浓度较低的儿童eGFR下降明显更快。紫绀型心脏病患儿在所有时间点的eGFR中位数均较低，但eGFR下降速度并不快。
BackgroundChildren 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.MethodsWe 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.ResultsOf 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 β = 0.04 (95% CI: 0.00–0.09;p= 0.07) IL-18 β = 0.07 (95% CI: 0.01–0.13;p= 0.04), ml/min/1.73 m2per month).ConclusionsAt 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.Graphical abstractA higher-resolution version of the Graphical abstract is available as Supplementary information.