Predictors of chronic kidney disease in children who underwent surgical correction of congenital heart disease: a long-term follow-up cohort study

ABSTRACT Introduction: Chronic kidney disease (CKD) has emerged as a relevant late complication in patients who have undergone surgical correction of congenital heart disease (CHD). Albuminuria has been highlighted as an early marker of subclinical renal injury, which may precede a reduction in glomerular filtration rate (GFR). Objective: To assess late renal outcomes in patients who underwent surgical correction of CHD and to identify independent predictors for the development of CKD. Methods: A retrospective cohort study including patients who underwent pediatric cardiac surgery with long-term outpatient follow-up. Renal function was assessed through estimated GFR and the presence of albuminuria. Clinical, surgical, and genetic variables were analyzed using a multivariate logistic regression model. Results: CKD was observed in 20.6% of patients, while albuminuria was present in 16.4%. In the multivariate analysis, the presence of a genetic syndrome was identified as an independent predictor of CKD (OR 4.06; 95% CI 1.29–12.74). A RACHS-1 surgical score of 2 had a protective effect on renal outcomes. Conclusions: Genetic syndromes represent a significant risk factor for the progression of renal injury, while surgeries of lower complexity are associated with a better prognosis. These findings reinforce the importance of early screening for albuminuria and long-term nephrological follow-up in this population.