van Hassel, Gaston (2022) Prevalence, predictors and prognostic value of renal dysfunction in patients with the Fontan circulation. thesis, Medicine.
Full text available on request.Abstract
Background: Nephropathy in the Fontan population is a complication that has barely been explored. Our aim was to compare renal function assessed with creatinine (eGFRcr) or cystatin C (eGFRcys) and to identify their determinants in Fontan patients. Furthermore, we aimed to investigate the association of renal function with outcome. Methods and results: In this single centre prospective study we included 90 Fontan patients who visited our outpatient clinic of Congenital Heart Diseases in 2012. Mean age at baseline 21.8 ± 9.5 years. Mean eGFRcr was 109 ± 18 ml/min/m2 and mean eGFRcys was 102 ± 21 ml/min/1.73m2 (p<0.001). Eleven percent of our population had an eGFRcr <90ml/min/1.73m2, as opposed to 25% when using cystatin C. Linear regression analyses identified pre-Fontan pulmonary artery pressure (PAP) as a key determinant for low eGFRcr and low eGFRcys (St. β -0.27; P=0.050 & St. β -0.52; P≤0.001 respectively). After a median follow-up of 9.1 (8.9-9.3) years, 10 (11%) patients died and 37 (41%) patients were admitted to hospital. Multivariable Cox regression analyses showed that lower eGFRcr and eGFRcys were independently associated with higher risk of mortality (HR 5.5; 95% CI 1.5 to 20.6; P=0.01 and HR 13.21; 95% CI: 1.0 to 169.0; P=0.047, respectively). However, no association was found between eGFR and the combined outcome of mortality and hospital admission. Conclusion: Creatinine-based eGFR is higher than Cystatin C-based eGFR in Fontan patients. Increased pre-Fontan PAP appeared to be a key determinant for renal dysfunction after Fontan completion. Furthermore, eGFR levels are associated with long-term mortality in the Fontan population. Our findings warrant further research to investigate the potential detrimental role of renal dysfunction in Fontan patients.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | van Melle, Dr. J.P. |
| Faculty: | Medical Sciences |
| Date Deposited: | 17 Jul 2023 11:08 |
| Last Modified: | 17 Jul 2023 11:08 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3585 |
Actions (login required)
 |
View Item |