Document Detail


Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease.
MedLine Citation:
PMID:  18443238     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Renal insufficiency in patients with ischemic heart disease and acquired heart failure is associated with higher mortality and morbidity. We studied the prevalence of renal dysfunction in adult patients with congenital heart disease (ACHD) and its relation to outcome. METHODS AND RESULTS: A total of 1102 adult patients with congenital heart disease (age 36.0+/-14.2 years) attending our institution between 1999 and 2006 had creatinine concentration measured. Glomerular filtration rate (GFR) was calculated with the Modification of Diet in Renal Disease equation. Patients were divided into groups of normal GFR (> or =90 mL . min(-1) . 1.73 m(-2)), mildly impaired GFR (60 to 89 mL . min(-1) . 1.73 m(-2)), and moderately/severely impaired GFR (<60 mL . min(-1) . 1.73 m(-2)). Survival was compared between GFR groups by Cox regression. Median follow-up was 4.1 years, during which 103 patients died. Renal dysfunction was mild in 41% of patients and moderate or severe in 9%. A decrease in GFR was more common among patients with Eisenmenger physiology, of whom 72% had reduced GFR (<90 mL . min(-1) . 1.73 m(-2), P<0.0001 compared with the remainder), and in 18%, this was moderate or severe (P=0.007). Renal dysfunction had a substantial impact on mortality (propensity score-weighted hazard ratio 3.25, 95% CI 1.54 to 6.86, P=0.002 for moderately or severely impaired versus normal GFR). CONCLUSIONS: Deranged physiology in adult patients with congenital heart disease is not limited to the heart but also affects the kidney. Mortality is 3-fold higher than normal in the 1 in 11 patients who have moderate or severe GFR reduction.
Authors:
Konstantinos Dimopoulos; Gerhard-Paul Diller; Evdokia Koltsida; Antonia Pijuan-Domenech; Sofia A Papadopoulou; Sonya V Babu-Narayan; Tushar V Salukhe; Massimo F Piepoli; Philip A Poole-Wilson; Nicky Best; Darrel P Francis; Michael A Gatzoulis
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-04-28
Journal Detail:
Title:  Circulation     Volume:  117     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-06     Completed Date:  2008-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2320-8     Citation Subset:  AIM; IM    
Affiliation:
Adult Congenital Heart Centre, Royal Brompton Hospital & National Heart and Lung Institute, Imperial College School of Medicine, London SW3 6NP, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adult
Female
Follow-Up Studies
Glomerular Filtration Rate / physiology
Heart Defects, Congenital / diagnosis*,  epidemiology*,  physiopathology
Humans
Male
Middle Aged
Predictive Value of Tests
Prevalence
Prognosis
Renal Insufficiency / diagnosis*,  epidemiology*,  physiopathology
Grant Support
ID/Acronym/Agency:
//British Heart Foundation
Comments/Corrections
Comment In:
Circulation. 2008 May 6;117(18):2311-2   [PMID:  18458179 ]

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