Long-Term Consequences of Acute Kidney Injury After Pediatric Cardiac Surgery: A Systematic Review

Objective The objective of this study was to evaluate the available data on long-term kidney dysfunction, hyper-tension, and mortality after cardiac surgery-associated acute kidney injury (AKI) in the pediatric population. Study design PubMed/MEDLINE, Embase, Scopus, and reference lists of relevant articles were searched for eligible studies published from inception through March 2022. Long-term outcomes after pediatric cardiac surgery complicated by AKI and those without were investigated. Results We identified 14 studies published between 2013 and 2022 that included a total of 6701 patients (AKI: 1376 patients; no AKI: 5325 patients). These studies used different well-established classifications to define AKI. All the studies suggested that AKI after heart surgery is common in the pediatric patient population and reported a potential link between cardiac surgery-associated AKI and important clinical outcomes. However, only 4 out of 11 studies found a strong association between (absence of recovery from) cardiac surgery-associated AKI and risk of developing chronic kidney disease, and 3 out of 5 studies found a significant increase in mortality rates for pediatric patients who developed AKI after cardiac surgery. Only 1 out of 4 studies found an association between AKI and hypertension at 12 months postoperatively, but found no association at later follow-up times. Conclusions Although there is a trend, evidence on the long-term consequences of cardiac surgery-associated AKI in the pediatric population is mixed. Genetic syndromes, preexisting kidney disease, univentricular or cyanotic heart conditions, and/or high-complexity surgery may be more important for the development of kidney dysfunction by adolescence and early adulthood. Regardless, these children may benefit from a long-term kidney follow-up.

Automated summary

The study aimed to evaluate the long-term consequences of cardiac surgery-associated acute kidney injury (AKI) in the pediatric population. The results showed that AKI after heart surgery is common in pediatric patients and may be linked to important clinical outcomes. However, the evidence on the long-term consequences of cardiac surgery-associated AKI in the pediatric population is mixed.