Chronic kidney damage in the adult Fontan population

Lee, D.; Levin, Adeera; Kiess, Marla; Sexsmith, George; Chakrabarti, S.; Barlow, Aaron; Human, Derek G.; Grewal, Jasmine

doi:10.1016/j.ijcard.2017.11.118

Cited by 45 publications

(25 citation statements)

References 17 publications

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“…evidence of CKD in close to half of an adult-aged Fontan cohort using combined criteria based on mGFR and urine ACR [18]. The precise mechanisms leading to renal impairment in Fontan patients remain unclear, but it is possible that these changes are progressive and related to the physiological stress imposed by the Fontan state.…”

Section: Discussionmentioning

confidence: 99%

Hepatic and renal end-organ damage in the Fontan circulation: A report from the Australian and New Zealand Fontan Registry

Wilson

d’Udekem

Winlaw

et al. 2018

International Journal of Cardiology

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In the second decade after Fontan hepatic and renal structure and function are abnormal in a significant number of patients: close to 60% have ultrasonographic evidence of structural hepatic abnormalities, 46% have elevated serum hepatic fibrosis scores, and 57% have either reduced glomerular filtration rate or microalbuminuria. Hepatic and renal function should be monitored for potential impacts on outcomes after Fontan completion.

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Section: Discussionmentioning

confidence: 99%

Hepatic and renal end-organ damage in the Fontan circulation: A report from the Australian and New Zealand Fontan Registry

Wilson

d’Udekem

Winlaw

et al. 2018

International Journal of Cardiology

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“…The Fontan circulatory state is recognized as a heart failure syndrome with neurohormonal activation, 22 liver disease, 23 lymphatic dysfunction, 24 and kidney disease. 25 Frailty is a common syndrome in patients with chronic heart failure and is associated with an increased risk of death and hospitalization. 10,[26][27][28] The complex and multifactorial nature of frailty hinders a uniform definition.…”

Section: Frailty and Muscle Wasting In The Fontan Populationmentioning

confidence: 99%

Abdominal Skeletal Muscle Index as a Potential Novel Biomarker in Adult Fontan Patients

et al. 2020

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Background: Fontan palliation results in a chronic multisystem disorder with diminished exercise capacity and increased risk of muscle wasting. The aims of this study were to assess the feasibility of skeletal muscle mass measurements in Fontan patients undergoing magnetic resonance imaging liver surveillance to compare muscle mass with a historic control and to assess its correlation with cardiorespiratory fitness. Methods: Skeletal muscle area (SMA) and skeletal muscle index (SMI) were measured at T12 and L3. A young, healthy historic cohort was used as a comparison group.

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“…Implications of FALD vary from a subacute course with limited clinical significance to complications such as synthetic liver dysfunction and hepatocellular carcinoma . Chronic kidney disease is also highly prevalent in adult Fontan patients with one study demonstrating at least mildly reduced glomerular filtration rates in the majority …”

Section: Introductionmentioning

confidence: 99%

“…4,5 Chronic kidney disease is also highly prevalent in adult Fontan patients with one study demonstrating at least mildly reduced glomerular filtration rates in the majority. 6 The model for end-stage liver disease (MELD) score is a commonly used scoring system to assess clinically significant liver disease and includes bilirubin, INR, and creatinine. 7 The MELD-XI score, which eliminates INR from the scoring system, is useful in the Fontan population given the prevalence of warfarin use.…”

Section: Introductionmentioning

confidence: 99%

More than the heart: Hepatic, renal, and cardiac dysfunction in adult Fontan patients

Byrne

Weingarten

Clark

et al. 2019

Congenital Heart Disease

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Setting Fontan‐associated liver disease universally affects adults with single ventricle heart disease. Chronic kidney disease is also highly prevalent in adult Fontan patients. In this study, we evaluate the relationship of Fontan hemodynamics invasively and noninvasively with extra‐cardiac dysfunction as measured by MELD and MELD‐XI. Objective We hypothesize that invasive and noninvasive measures of Fontan circuit congestion and ventricular dysfunction are associated with increased MELD and MELD‐XI scores. Design Single‐center data from adults with Fontan palliation who had ongoing care, including cardiac catheterization, were retrospectively collected. Hemodynamic data from cardiac catheterization and echocardiographic assessment of ventricular and atrioventricular valve function were tested for association with serum creatinine, MELD, and MELD‐XI. Linear regression was used to perform multivariable analysis in the echocardiogram cohort. Results Fifty‐seven patients had congruent lab and catheterization data for analysis. Sixty‐three and sixty‐nine patients had congruent lab and echocardiogram data for MELD and MELD‐XI, respectively. Of the hemodynamic variables analyzed, only decreased systemic oxygen saturation had significant correlation with elevated MELD and MELD‐XI (P = .045). Patients with moderately or severely reduced ejection fraction by echocardiogram had significantly higher MELD and MELD‐XI scores compared to those with normal or mildly depressed systolic ventricular function (P = .008 and P < .001 for MELD and MELD‐XI, respectively). Significant differences in creatinine were also found among the ventricular dysfunction groups (P = .02). Conclusions In adults following Fontan palliation, systolic ventricular dysfunction and decreased oxygen saturation were associated with hepatic and renal dysfunction as assessed by elevated serum creatinine, MELD, and MELD‐XI scores.

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Chronic kidney damage in the adult Fontan population

Cited by 45 publications

References 17 publications

Hepatic and renal end-organ damage in the Fontan circulation: A report from the Australian and New Zealand Fontan Registry

Hepatic and renal end-organ damage in the Fontan circulation: A report from the Australian and New Zealand Fontan Registry

Abdominal Skeletal Muscle Index as a Potential Novel Biomarker in Adult Fontan Patients

More than the heart: Hepatic, renal, and cardiac dysfunction in adult Fontan patients

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