Surgical repair of congenital heart disease increases child’s risk of death and ESKD

Children who undergo cardiac surgery for congenital heart disease are at increased risk for both long-term end stage kidney disease (ESKD) and mortality, according to a new study in the Clinical Journal of American Society of Nephrology.

Researchers conducted a cohort study of 3600 children with congenital heart disease who had their first surgery within 10 years of birth. The cohort was from Ontario, Canada, where every child had universal access to healthcare services. Each child in the cohort was matched to 10 other children who did not have congenital heart disease but had similar demographic markers, including age, neighborhood, index date, rurality, and sex.

Researcher followed these children for a median of 5.9 years after their surgical repair. Twenty-two percent were low birth weight (<2500 g), and median age at first surgery was 150 days. During follow-up, 140 children died and 52 reached ESKD. When compared with the matched control population with no congenital heart disease, the cumulative incidence of death and ESKD at 1, 5, and 10 years was higher (death: 3% vs 0.06%, 4% vs 0.10%, and 5% vs 0.13%, respectively; ESKD: 1% vs 0.00%, 2% vs 0.02%, and 2% vs 0.02%, respectively).

Additionally, 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.

Their findings highlight the importance of monitoring for long-term kidney dysfunction after cardiac surgery. 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 both ESKD and mortality was at highest in the first year after surgery. Researchers noted that this highlights the importance of closer outpatient follow-up after surgery and new risk stratification approaches to identify children at highest risk.