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Creatinine-based estimation of glomerular filtration rate in patients with a Fontan circulation.
Wilson, Thomas G; d'Udekem, Yves; Winlaw, David S; Cordina, Rachael L; Ayer, Julian; Gentles, Thomas L; Weintraub, Robert G; Grigg, Leeanne E; Cheung, Michael; Cain, Timothy M; Rao, Padma; Verrall, Charlotte; Plessis, Karin Du; Rice, Kathryn; Iyengar, Ajay J.
Afiliación
  • Wilson TG; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
  • d'Udekem Y; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
  • Winlaw DS; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
  • Cordina RL; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
  • Ayer J; Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
  • Gentles TL; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
  • Weintraub RG; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
  • Grigg LE; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
  • Cheung M; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
  • Cain TM; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
  • Rao P; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.
  • Verrall C; Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
  • Plessis KD; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
  • Rice K; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.
  • Iyengar AJ; Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Congenit Heart Dis ; 14(3): 454-463, 2019 May.
Article en En | MEDLINE | ID: mdl-30664330
BACKGROUND: Patients with a Fontan circulation are at risk of renal dysfunction. We analyzed cross-sectional data in pediatric and adult Fontan patients in order to assess the accuracy of commonly used serum creatinine-based methods in estimating glomerular filtration rate (GFR). METHODS: A total of 124 Fontan patients (58 children, 66 adults) were enrolled across three study centers. Measurement of GFR (mGFR) using in vivo 99m Tc-DTPA clearance was performed. Various serum creatinine-based equations were used to calculate estimated GFR (eGFR). RESULTS: Mean mGFR was 108 ± 28 mL/min/1.73 m2 in children and 92 ± 20 mL/min/1.73 m2 in adults. Fourteen children (25%) and 28 adults (45%) had an mGFR <90 mL/min/1.73 m2 . There was no significant correlation between mGFR and eGFR (Schwartz) in children (r = 0.22, P = .1), which substantially overestimated mGFR (bias 50.8, 95%CI: 41.1-60.5 mL/min/1.73 m2 , P < .0001). The Bedside Schwartz equation also performed poorly in the children (r = 0.08, P = .5; bias 5.9, 95%CI: -2.9-14.6 mL/min/1.73 m2 , P < .0001). There was a strong correlation between mGFR and both eGFR (CKD-EPI) and eGFR (MDRD) in adults (r = 0.67, P < .0001 in both cases), however, both methods overestimated mGFR (eGFR(CKD-EPI):bias 23.8, 95%CI: 20-27.6 mL/min/1.73 m2 , P < .0001; eGFR (MDRD):bias 16.1, 95%CI: 11.8-20.4 mL/min/1.73 m2 , P < .0001). None of the children with an mGFR <90 mL/min/1.73 m2 had an eGFR (Schwartz) <90 mL/min/1.73 m2 . Sensitivity and specificity of eGFR (CKD-EPI) and eGFR (MDRD) for mGFR <90 mL/min/1.73 m2 in adults were 25% and 92% and 39% and 100%, respectively. CONCLUSIONS: This study identifies the unreliability of using creatinine-based equations to estimate GFR in children with a Fontan circulation. The accuracy of formulas incorporating cystatin C should be further investigated and may aid noninvasive surveillance of renal function in this population.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan / Creatinina / Tasa de Filtración Glomerular / Cardiopatías Congénitas / Riñón / Enfermedades Renales / Modelos Biológicos Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Female / Humans / Male País/Región como asunto: Oceania Idioma: En Revista: Congenit Heart Dis Asunto de la revista: CARDIOLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Procedimiento de Fontan / Creatinina / Tasa de Filtración Glomerular / Cardiopatías Congénitas / Riñón / Enfermedades Renales / Modelos Biológicos Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Child / Female / Humans / Male País/Región como asunto: Oceania Idioma: En Revista: Congenit Heart Dis Asunto de la revista: CARDIOLOGIA Año: 2019 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos