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Renal dysfunction is associated with higher central venous pressures in patients with Fontan circulation

Christopher R Broda1, Hamsini Sriraman2, Devanshi Wadhwa2

  • 1Department of Pediatrics, Section of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.

Congenital Heart Disease
|August 7, 2018
PubMed

Insights

Renal dysfunction in Fontan circulation patients is linked to higher central venous pressure (CVP) and factors influencing it. African Americans with Fontan circulation may face a higher risk of kidney issues.

Area of Science:

  • Cardiology
  • Nephrology
  • Pediatric Cardiology

Background:

  • Elevated central venous pressure (CVP) negatively impacts organ systems in Fontan circulation patients.
  • The specific relationship between CVP and estimated glomerular filtration rate (eGFR) in this population remains understudied.

Purpose of the Study:

  • To investigate the association between CVP and eGFR in patients with Fontan circulation.
  • To identify factors contributing to renal dysfunction in this patient group.

Main Methods:

  • Analysis of 67 Fontan circulation patients undergoing catheterization (1987-2015) with pre-procedure serum creatinine.
  • Exclusion of patients with primary kidney disease; eGFR calculated using Schwartz or MDRD equations.
  • Definition of renal dysfunction (RD) as eGFR < 90 mL/min/1.73m²; comparison of demographics, comorbidities, hemodynamics, and lab values between groups.

Main Results:

  • Renal dysfunction (RD) was present in 22% of patients (15/67).
  • Patients with RD exhibited significantly higher CVP (18.0 vs 13.5 mm Hg, P=0.001) and lower pulmonary blood flow.
  • RD was also associated with higher ventricular end-diastolic pressure, increased atrioventricular valve regurgitation, and a higher prevalence among African Americans (P=0.009).

Conclusions:

  • Renal dysfunction in Fontan circulation is associated with elevated CVP and related factors.
  • African American patients with Fontan circulation may be at increased risk for renal dysfunction.
  • Further research is needed to understand the impact of venous congestion on renal function in Fontan patients.
Abstract

Keywords:
Fontan circulationcentral venous pressureglomerular filtration ratekidney dysfunctionrenal functionvenous congestion

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