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- Title
Long-Term Renal Involvement in Association with Fontan Circulation.
- Authors
Muraoka, Mamoru; Nagata, Hazumu; Yamamura, Kenichiro; Sakamoto, Ichiro; Ishikita, Ayako; Nishizaki, Akiko; Eguchi, Yoshimi; Fukuoka, Shoji; Uike, Kiyoshi; Nagatomo, Yusaku; Hirata, Yuichiro; Nishiyama, Kei; Tsutsui, Hiroyuki; Ohga, Shouichi
- Abstract
Multiorgan dysfunction is a concern of Fontan patients. To clarify the pathophysiology of Fontan nephropathy, we characterize renal disease in the long-term observational study. Medical records of 128 consecutive Fontan patients [median age: 22 (range 15–37) years old] treated between 2009 and 2018 were reviewed to investigate the incidence of nephropathy and its association with other clinical variables. Thirty-seven patients (29%) showed proteinuria (n = 34) or < 90 mL/min/1.73 m2 of estimated glomerular filtration rate (eGFR) (n = 7), including 4 overlapping cases. Ninety-six patients (75%) had liver dysfunction (Forns index > 4.21). Patients with proteinuria received the Fontan procedure at an older age [78 (26–194) vs. 56 (8–292) months old, p = 0.02] and had a higher cardiac index [3.11 (1.49–6.35) vs. 2.71 (1.40–4.95) L/min/m2, p = 0.02], central venous pressure [12 (7–19) vs. 9 (5–19) mmHg, p < 0.001], and proportion with > 4.21 of Forns index (88% vs. 70%, p = 0.04) than those without proteinuria. The mean renal perfusion pressure was lower in patients with a reduced eGFR than those without it [55 (44–65) vs. 65 (45–102) mmHg, p = 0.03], but no other variables differed significantly. A multivariable analysis revealed that proteinuria was associated with an increased cardiac index (unit odds ratio 2.02, 95% confidence interval 1.12–3.65, p = 0.02). Seven patients with severe proteinuria had a lower oxygen saturation than those with no or mild proteinuria (p = 0.01, 0.03). Proteinuria or a decreased eGFR differentially occurred in approximately 30% of Fontan patients. Suboptimal Fontan circulation may contribute to the development of proteinuria and reduced eGFR.
- Subjects
CENTRAL venous pressure; GLOMERULAR filtration rate; CARDIAC surgery; OXYGEN saturation
- Publication
Pediatric Cardiology, 2024, Vol 45, Issue 2, p340
- ISSN
0172-0643
- Publication type
Article
- DOI
10.1007/s00246-023-03334-3