Renal function assessment in child and adolescent heart transplant recipients during routine cardiac catheterization

Abstract

CKD identification after pediatric heart transplantation (PHT) is limited by inaccuracies in estimates of GFR. We hypothesized that GFR can be measured by a modified iohexol clearance protocol in PHT recipients and that the CKiD formula provides a better estimate of GFR than other estimating equations. A cross-sectional study of PHT recipients, ages 2-18 yr, undergoing coronary angiography was undertaken. The angiography dose of iohexol was divided by the area under the curve from three iohexol levels post-infusion to calculate GFR. Agreement between iGFR and multiple estimating equations (eGFR) was assessed. In 31 subjects, median age was 15.0 yr (IQR 7.6, 16.6). Mean iGFR was 93.8 (s.d. 22.5) mL/min/1.73 m(2) ; 16 (52%) had an iGFR <90 mL/min/1.73 m(2) . The full CKiD formula (mean eGFR 88.9, s.d. 14.9) had low bias (-5.0), narrowest 95% limits of agreement (-42.0, 32.1), highest 30% (94%) and 10% (52%) accuracy, and highest correlation coefficient (0.576) relative to iGFR. We describe a novel modified iohexol clearance method to assess GFR after PHT. Over half of the cohort had an iGFR <90, suggesting CKD. The full CKiD formula performs best with respect to bias, accuracy, and correlation.

Chronic kidney disease after heart transplantation: a single-centre retrospective study at Skåne University Hospital in Lund 1988-2010

“…There was also a tendency towards positive bias (12.2 ± 13.2 and 15.5 ± 19.6 ml/min/1.73 m 2 ). Compared with the few earlier studies that have evaluated the two equations in HT patients , our results indicated slightly lower ‘P30‐values’, and slightly higher positive bias, for both formulae. Nonetheless, it still appears as if both estimating equations tend to overestimate GFR in HT patients.…”

Progression of chronic kidney disease after acute kidney injury

“…25–27 This has been substantiated in several studies of children and young adults with congenital heart disease, in whom a decrease in eGFR, 28 increased proteinuria, 29 or increased urinary excretion of tubular injury biomarkers such as N-acetyl-β-D-glucosaminidase and α1-microglobulin 30,31 has been demonstrated in 30–50% of the subjects studied. In children who received a heart transplant for congenital heart disease or dilated cardiomyopathy, more than 50% were found to have a diminished eGFR at a median of 6 years of follow up.…”

“…In children who received a heart transplant for congenital heart disease or dilated cardiomyopathy, more than 50% were found to have a diminished eGFR at a median of 6 years of follow up. 27 Importantly, in a large single center study of 1102 adults with congenital heart disease, 50% had CKD based on a decrease in eGFR. 32 In comparison with the general population, the prevalence of CKD was 18-fold higher in patients with non-cyanotic heart disease, and 35-fold higher in those with cyanotic heart disease.…”

Assessment of Kidney Function in Survivors Following Fontan Palliation

“…Risk Factors for eGFR<90 mL/min/1.73 m 2 within the Fontan Cohort been highlighted in several studies [16][17][18]. In the study by Ylinen et al, eGFR of 52 pediatric patients with various renal conditions was determined via 51…”