Hypertension and CKD at 7 Years After Surgical Repair of Congenital Heart Disease in Children
Bibliographic record
Abstract
Background: We previously determined that children who require surgery for congenital heart disease (CHD) are at an increased risk for hypertension and CKD 5 years after cardiac surgery. This study assessed the long-term risk of hypertension and CKD after cardiac surgery and if these outcomes are sustained. Methods: We prospectively enrolled children from 1 month to 18 years old, undergoing cardiopulmonary bypass at three centers. Children who survived their surgical hospitalization had blood pressure, urine albumin to creatinine ratio, and serum creatinine measured at two in-person follow-up visits (median 5.4 years and 7.4 years after surgery). Hypertension was defined using the American Academy of Pediatrics 2017 Hypertension guidelines. Estimated GFR (eGFR) was calculated using the CKiD equation. CKD was defined as the presence of low eGFR (<90 ml/min/1.73m2) or microalbuminuria. We compared the risk of hypertension and CKD status at the 5 and 7-year visits using the McNemar test. Results: Of 131 children with a follow-up visit 5 years after cardiac surgery, 88 (67%) children participated in the 7-year follow-up visit. The median age of the cohort at the 7-year follow-up was 10.7 [IQR: 7.8-13.0] years and 47% were female. 32 children had previously had a septal defect repair, 15 an inflow/outflow tract or valve procedure, 34 had a combined procedure, and 7 were not defined. Hypertension, microalbuminuria, eGFR<90, and eGFR<60 was 15%, 8%, 9%, and 1%, respectively, at the 5-year visit and 17%, 4%, 19%, and 1%, respectively, at the 7-year visit. CKD was present in 16% and 18% of children at the 5-year and 7-year visit, respectively, with no statistically significant change in risk at the two visits (p=0.35). Between the 5-year and 7-year visits, hypertension and CKD were sustained in 8 (62%) and 4 (29%) patients, respectively. Conclusions: The long-term risk of hypertension and CKD were common at the 7-year visit. Compared to the five-year visit, hypertension was sustained in the majority of children. Although CKD was not sustained, there was an increased incidence of new children with GFR<90 at the 7-year visit. The risk factors for sustained hypertension and kidney disease should be further studied in children with congenital heart disease. Funding: NIDDK Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".