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Updated: Jun 17, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease
Jillian Olsen1, Hari Tunuguntla1, Alexander Alali1
1Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
Insights
In children with cardiovascular disease, higher central venous pressure (CVP) is linked to lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF). This finding highlights CVP as a key predictor of kidney issues in pediatric patients.
Area of Science:
- Pediatric Cardiology
- Renal Medicine
- Cardiovascular Physiology
Background:
- Traditionally, low cardiac output was thought to drive renal dysfunction.
- Adult studies indicate central venous pressure (CVP) is a more significant factor in renal health.
- Pediatric cardiovascular disease presents unique challenges in understanding hemodynamic influences on kidney function.
Purpose of the Study:
- To investigate the hypothesis that elevated CVP predicts reduced estimated glomerular filtration rate (eGFR) in pediatric patients with cardiovascular disease.
- To determine if higher CVP is associated with worsening renal function (WRF) within 180 days post-cardiac catheterization.
- To clarify the independent role of CVP versus cardiac index in pediatric renal outcomes.
Main Methods:
- A single-center cohort study included patients aged 3 months to 21 years with biventricular circulation.
- Cardiac catheterization data were analyzed, including CVP, cardiac index, and contrast volume.
- Statistical analyses included Pearson's correlation, linear regression for eGFR, and Cox regression for WRF prediction.
Main Results:
- Higher CVP was independently associated with lower eGFR (β = -2.65, P < 0.001) and predicted WRF (HR = 1.10, P = 0.002).
- Cardiac index was not significantly associated with eGFR or WRF in multivariable analysis.
- A CVP of ≥7 mm Hg predicted WRF (HR = 2.57, P = 0.007), and greater contrast volume also predicted WRF.
Conclusions:
- Elevated central venous pressure (CVP) is a significant predictor of lower eGFR and worsening renal function in children with cardiovascular disease.
- CVP's association with renal outcomes is independent of cardiac index, suggesting a distinct pathophysiological mechanism.
- These findings underscore the importance of monitoring CVP in pediatric patients at risk for renal complications.
Background:
Traditionally, low cardiac output has been considered the primary hemodynamic driver of renal function and injury. Adult data suggest that central venous pressure (CVP) is a more important factor.
Objectives:
The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF).
Methods:
We performed a single-center cohort study of patients aged 3 months to 21 years with biventricular circulation undergoing cardiac catheterization. Pearson's correlation and linear and Cox regression analyses were performed to determine associations with eGFR at the time of catheterization and WFR within 180 days after catheterization.
Results:
312 patients had median age 7.9 years (IQR: 2.3 to 14.5 years), median eGFR 97 mL/min/1.73 m2 (IQR: 81-118 mL/min/1.73 m2), median CVP 7 mm Hg (IQR: 5-9 mm Hg), and median cardiac index 3.7 mL/min/m2 (IQR: 2.9-4.6 mL/min/m2). Nearly half (48%) were transplant recipients. In multivariable analysis, CVP was independently associated with eGFR (β = -2.65; 95% CI: -4.02, -1.28; P < 0.001), as was being a transplant recipient (β = -10.20; 95% CI: -17.74, -2.65; P = 0.008), while cardiac index was not. Fifty-one patients (16%) developed WRF. In a proportional hazards model adjusting for cardiac index, only higher CVP (HR: 1.10; 95% CI: 1.04-1.17; P = 0.002) and greater contrast volume by weight (HR: 1.05; 95% CI: 1.01-1.10; P = 0.021) predicted WRF. CVP ≥7 mm Hg likewise predicted WRF (HR: 2.57; 95% CI: 1.29-5.12; P = 0.007).
Conclusions:
Among children with a spectrum of cardiovascular disease, higher CVP is associated with lower eGFR and development of WRF, independent of cardiac index.
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