Determinants and prognostic value of albuminuria in adult patients with congenital heart disease

Ohuchi, Hideo; Mori, Aki; Fujita, Akira; Kurosaki, Kenichi; Shiraishi, Isao; Nakai, Michikazu

doi:10.1016/j.ahj.2023.04.017

Cited by 2 publications

(3 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…ACR has been associated with death in patients with a Fontan circulation, independently from eGFR. 26 Interestingly, the same factors that determined eGFR were not associated with ACR. Nonetheless, albuminuria was highly prevalent among patients with a Fontan circulation, even during very early follow‐up after the procedure.…”

Section: Discussionmentioning

confidence: 95%

“… 25 Albuminuria is considered an early sign of kidney dysfunction, even in the presence of normal eGFR, and has been shown an independent risk factor for progressive GFR decline. 26 Given the eGFR decline rate of −1.83 mL/min per 1.73 m 2 per year, it is expected that as these patients age, progressively more of them will develop reduced kidney function.…”

Section: Discussionmentioning

confidence: 99%

“…A number of these disturbances manifest in patients on a Fontan trajectory, such as chronic cyanosis, volume/pressure overload, stress induced by repeated surgeries and prolonged hospital stays, and malnutrition, among other factors. Recent research by Ohuchi et al 26 has pinpointed elevated aortic systolic pressure and increased glycated hemoglobin levels as correlates of albuminuria in patients with a Fontan circulation. Additionally, chronic cyanosis and univentricular heart conditions have been associated with multiple indicators of tubular injury.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Noninvasive Advanced Cardiovascular Magnetic Resonance–Derived Fontan Hemodynamics Are Associated With Reduced Kidney Function But Not Albuminuria

Van den Eynde,

Westenberg,

Hazekamp

et al. 2024

JAHA

View full text Add to dashboard Cite

Background Kidney disease is the most important predictor of death in patients with a Fontan circulation, yet its clinical and hemodynamic correlates have not been well established. Methods and Results A total of 53 ambulatory patients with a Fontan circulation (median age, 16.2 years, 52.8% male patients) underwent advanced cardiovascular magnetic resonance assessment, including 4‐dimensional flow imaging and computational fluid dynamics. Estimated glomerular filtration rate (eGFR) <90 mL/min per 1.73 m 2 was observed in 20.8% and albumin‐to‐creatinine ratio >3 mg/mmol in 39.6%. The average eGFR decline rate was −1.83 mL/min per 1.73 m 2 per year (95% CI, −2.67 to −0.99; P <0.001). Lower eGFR was associated with older age, larger body surface area at examination, longer time since Fontan procedure, and lower systemic ventricular ejection fraction. Higher albumin‐to‐creatinine ratio was associated with absence of fenestration at the Fontan operation, and older age and lower systemic ventricular ejection fraction at the assessment. Lower cross‐sectional area of the Fontan conduit indexed to flow (r=0.32, P =0.038), higher inferior vena cava–conduit velocity mismatch factor (r=−0.35, P =0.022), higher kinetic energy indexed to flow in the total cavopulmonary connection (r=−0.59, P =0.005), and higher total cavopulmonary connection resistance (r=−0.42, P =0.005 at rest; r=−0.43, P =0.004 during exercise) were all associated with lower eGFR but not with albuminuria. Conclusions Kidney dysfunction and albuminuria are common among clinically well adolescents and young adults with a Fontan circulation. Advanced cardiovascular magnetic resonance–derived metrics indicative of declining Fontan hemodynamics are associated with eGFR and might serve as targets to improve kidney health. Albuminuria might be driven by other factors that need further investigation.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation