Biomarkers of eGFR decline after cardiac surgery in children: findings from the ASSESS-AKI study

Christina de Fontnouvelle, Michael Zappitelli, Heather R. Thiessen-Philbrook, Yaqi Jia, Paul L. Kimmel, James S. Kaufman, Prasad Devarajan, Chirag R. Parikh, Jason H. Greenberg

Research output: Contribution to journalArticlepeer-review


Background: Children 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. Methods: We 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. Results: Of 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 m2 per month). Conclusions: At 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 abstract: [Figure not available: see fulltext.]

Original languageEnglish (US)
Pages (from-to)2851-2860
Number of pages10
JournalPediatric Nephrology
Issue number8
StatePublished - Aug 2023


  • Biomarker
  • CKD
  • CKD progression
  • Cardiac surgery
  • Congenital heart disease

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health


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