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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Assessment of Kidney Function in Survivors Following Fontan Palliation
Sheena Sharma1, Rebecca L Ruebner1, Susan L Furth1
1Division of Nephrology and, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Long-term survivors of the Fontan operation show early signs of kidney disease, with 10% having reduced kidney function and elevated parathyroid hormone levels. These findings suggest potential chronic kidney disease (CKD) in this patient population.
Area of Science:
- Pediatric Cardiology
- Nephrology
- Congenital Heart Disease Research
Background:
- The Fontan operation is a critical palliative surgery for single ventricle congenital heart disease.
- Long-term renal outcomes following the Fontan procedure are not well-established.
- Understanding kidney function in survivors is crucial for comprehensive long-term care.
Purpose of the Study:
- To evaluate long-term kidney function in individuals who have undergone the Fontan operation.
- To investigate the prevalence of chronic kidney disease (CKD) in this cohort.
- To compare renal function markers between Fontan survivors and healthy controls.
Main Methods:
- A retrospective cohort study compared 68 Fontan survivors with 70 healthy children.
- Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m².
- Creatinine and cystatin C-based equations were used to calculate eGFR; proteinuria and parathyroid hormone levels were also assessed.
Main Results:
- While median eGFR levels were comparable between groups, 10% of Fontan survivors exhibited an eGFR <90 mL/min/1.73 m².
- Fontan survivors had significantly higher median intact parathyroid hormone levels compared to controls (59.4 vs. 23.4 pg/mL).
- Proteinuria was observed in 10% of the Fontan group, compared to 4.7% in controls, although this difference was not statistically significant.
Conclusions:
- A notable proportion of long-term Fontan survivors demonstrate indicators of early kidney disease, including reduced eGFR and elevated parathyroid hormone.
- These findings suggest a potential for developing chronic kidney disease (CKD) in the post-Fontan population.
- Further longitudinal studies are warranted to monitor kidney function and identify risk factors for CKD in this unique cohort.
Objective:
The Fontan operation is a palliative procedure for congenital single ventricle heart disease. Long-term kidney function in this cohort is not well-known. Our aim was to evaluate renal function in long-term survivors post-Fontan palliation, and we hypothesize that this cohort will have a higher prevalence of chronic kidney disease (CKD) compared to controls.
Design:
We performed a retrospective cohort study of 68 subjects evaluated through the Single Ventricle Survivorship Program at the Children's Hospital of Philadelphia between July 2010 and December 2014 compared to 70 healthy children similar in age and sex. Primary outcome was CKD, defined as estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 using creatinine and cystatin C-based estimating equations. Secondary outcomes included proteinuria and elevated intact parathyroid hormone.
Results:
The Fontan cohort included 68 subjects with median age 13 years (IQR 9.0, 17.3) who were median 11.1 years (IQR 6.5, 15.7) post-Fontan palliation. This cohort was compared to 70 healthy individuals (median age 15.5 years (IQR 12.5, 18.3). Although median eGFRs were comparable: 102.6 vs. 101.9 mL/min/1.73 m2 (P = .89) in Fontan vs. healthy subjects <18 years of age (Full CKiD equation), and 128.5 vs. 129.7 mL/min/1.73 m2 (P = .56) in Fontan vs. healthy subjects ≥18 years of age (CKD-EPI creatinine and cystatin formula); 10% of Fontan subjects had an eGFR<90 mL/min/1.73 m2 . Median intact parathyroid hormone level was higher at 59.4 pg/mL (IQR 43.0, 83.1) in the Fontan group compared to 23.4 pg/mL (IQR 16.7, 30.0) in controls (P ≤ .001). Proteinuria was present in 10% of the Fontan group compared to 4.7% in controls (P = .27).
Conclusion:
Ten percent of long-term survivors post-Fontan palliation had eGFR <90 ml/min/1.73 m2 , and higher median parathyroid hormone levels compared to controls. Taken together, these measures may indicate early kidney disease. Future studies will focus on longitudinal assessment of kidney function and evaluation of risk factors for CKD post-Fontan palliation.
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