Creatinine-based estimation of glomerular filtration rate in patients with a Fontan circulation.

Autor: Wilson TG; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia., d'Udekem Y; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia., Winlaw DS; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia., Cordina RL; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia.; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia., Ayer J; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.; Department of Paediatrics, University of Sydney, Sydney, New South Wales, Australia., Gentles TL; Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand., Weintraub RG; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia., Grigg LE; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia., Cheung M; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.; Department of Cardiology, The Royal Children's Hospital, Melbourne, Victoria, Australia., Cain TM; Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia., Rao P; Medical Imaging Department, The Royal Children's Hospital, Melbourne, Victoria, Australia., Verrall C; The Heart Centre for Children, The Children's Hospital at Westmead, Sydney, New South Wales, Australia., Plessis KD; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia., Rice K; Greenlane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand., Iyengar AJ; Heart Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.; Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Jazyk: angličtina
Zdroj: Congenital heart disease [Congenit Heart Dis] 2019 May; Vol. 14 (3), pp. 454-463. Date of Electronic Publication: 2019 Jan 21.
DOI: 10.1111/chd.12746
Abstrakt: 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 m 2 in children and 92 ± 20 mL/min/1.73 m 2 in adults. Fourteen children (25%) and 28 adults (45%) had an mGFR <90 mL/min/1.73 m 2 . 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 m 2 , 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 m 2 , 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 m 2 , P < .0001; eGFR (MDRD):bias 16.1, 95%CI: 11.8-20.4 mL/min/1.73 m 2 , P < .0001). None of the children with an mGFR <90 mL/min/1.73 m 2 had an eGFR (Schwartz) <90 mL/min/1.73 m 2 . Sensitivity and specificity of eGFR (CKD-EPI) and eGFR (MDRD) for mGFR <90 mL/min/1.73 m 2 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.
(© 2019 Wiley Periodicals, Inc.)
Databáze: MEDLINE