About 30-50% of young individuals who undergo heart surgery also suffer from acute kidney damage (AKI). AKI following heart surgery has been linked to genetic variations that influence renal blood flow and inflammation in adult populations across the board, but this association has not been investigated in children. The purpose of this research was to determine whether or not certain prevalent candidate genetic variations are in fact linked to AKI in children who have undergone heart surgery. Between September 2007 and July 2020, 2,062 individuals at a single tertiary referral children’s hospital had surgery for congenital heart disease. Candidate gene variations (AGTR1, APOE, IL6, NOS3, and TNF) were selected beforehand. In the first postoperative week, AKI was characterized using the serum creatinine criteria from Kidney Disease: Improving Global Outcomes. Univariate and multivariate analyses of demographic, clinical, and genetic factors were utilized to assess outcomes. Median age at study enrollment was 6 months (IQR 1-53 months), and 759 (37.5%) of the sample group developed surgical AKI. Only NOS3 (rs2070744) was linked with reduced risk for AKI in unadjusted analysis of all genetic variants (OR 0.75, 95% CI 0.62-0.9, P=.002). The NOS3 variant was still protective against AKI in logistic regression analyses after controlling for body surface area, previously identified genetic syndrome, Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and nephrotoxic medication exposure (OR 0.7, 95% CI 0.58-0.85, P<.001). In children having heart surgery, a frequent variation in NOS3 is linked to a lower risk of acute kidney injury. Additional research on the role of genetics in postoperative AKI in children may assist in pinpointing those at greatest risk.
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