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Risk Factors for Chronic Kidney Disease in Adult Patients with Congenital Heart Disease and Its Relationship with
Efrén Martínez-Quintana1,2, Fayna Rodríguez-González3
1Cardiology Service, Complejo Hospitalario Universitario Insular-Materno Infantil, Avd. Marítima del Sur s/n, 35016 Las Palmas de Gran Canaria, Spain.
Insights
Adults with congenital heart disease (CHD) have a higher prevalence of chronic kidney disease (CKD). Age, cyanosis, and Down syndrome predict CKD risk in CHD patients, but only age independently predicts cardiovascular mortality.
Area of Science:
- Cardiology
- Nephrology
- Genetics
Background:
- Congenital heart disease (CHD) patients face increased risks for chronic kidney disease (CKD).
- CKD significantly impacts patient survival rates.
- Understanding CKD prevalence and risk factors in adult CHD is crucial.
Purpose of the Study:
- To determine the prevalence of CKD in adult CHD patients.
- To identify risk factors for CKD in this population.
- To assess the impact of CKD on cardiovascular mortality in adult CHD patients.
Main Methods:
- An observational, prospective cohort study design.
- Matching adult CHD patients with controls for age and sex.
- Utilizing binary logistic regression and Cox survival analysis.
Main Results:
- CKD prevalence was 4.5% in CHD patients versus 0.2% in controls.
- Key CKD risk factors in CHD include age, dyslipidemia, low iron, cyanosis, and Down syndrome.
- CKD was associated with worse cardiovascular survival, but only age remained an independent prognostic factor.
Conclusions:
- Adult CHD patients exhibit a substantially higher prevalence of CKD.
- Age, cyanosis, and Down syndrome are significant predictors of CKD risk in CHD.
- While CKD impacts survival, age is the sole independent predictor of cardiovascular mortality in this cohort.
Abstract:
Background: Patients with congenital heart disease (CHD) show risk factors for chronic kidney disease (CKD) and it is well known that CKD has a large negative impact on survival. Methods: Observational and prospective cohort study. Adult CHD patients and controls were matched for age and sex. Results: A total of 657 CHD adult patients (cases) and 1954 controls were studied. Median age in CHD patients was 30 (17-62) years and 373 (57%) were male. The prevalence of CKD (Glomerular filtration rate (GFR) < 60 mL/min/1.73 m2) was 0.2% and 4.5% in the control and CHD groups, respectively. Binary logistic regression analysis determined as risk factors for CKD in CHD patients: age [1.54 (1.04-1.28), p = 0.009], dyslipidemia [19.8 (1.35-301.1), p = 0.031], low iron concentration [0.96 (0.96-0.93), p = 0.048], cyanosis [25.7 (1.60-411.8), p = 0.022], and Down syndrome [46.8 (8.09-2710), p = 0.003]. During a follow-up time of 6.8 (1.2-10.5) years, cardiovascular mortality occurred in 31 patients with CHD showing, through the Kaplan-Meier test, a worse outcome among patients with CKD (p < 0.05) as was also seen in the univariate Cox regression survival analysis. However, after adjusting for other variables, this significance was lost, with age remaining as the unique independent prognostic factor. Conclusions: The prevalence of CKD was much higher in patients with CHD than in the control group; age, cyanosis, and Down syndrome were the predictors of a higher risk of CKD among CHD patients. Although CKD was associated with worse survival in CHD patients, only age was identified as an independent prognostic factor for cardiovascular mortality.
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