Prevalence, Outcome, and Predictors of Cardiorenal Syndrome in Children with Dilated Cardiomyopathy

Background: Cardiorenal syndrome (CRS) describes a variety of acute or chronic conditions where the primary failing organ can be either the heart or kidney. The prevalence, predictors and outcome of CRS have not been reported in children with dilated cardiomyopathy (DCM).Methodology: Data from patients > 1 year of age with DCM enrolled in the Pediatric Cardiomyopathy Registry (PCMR) were assessed. CRS was defined as estimated glomerular filtration rate (eGFR) <90 ml/min/1.73m2 by modified Schwartz formula. Patients with eGFR>150 ml/min/1.73m2 were excluded. CRS prevalence was determined by cross-sectional design in patients newly diagnosed with DCM using the baseline PCMR data. Survival analysis compared patients with vs. without CRS using annual PCMR data. Regression models were applied on both baseline and annual data to study the interactions between eGFR and different echocardiographic measures.Results: Data for 484 children with DCM were analyzed from the baseline data. eGFR were available for 92 patients. Fifty seven (62.0%) patients had eGFR < 90 ml/min/1.73m2 (CRS patients), which is greater than the 36.5% prevalence published in 3256 healthy historical controls (P<0.001). CRS patients had a mean eGFR of 62.0 (±22.6) vs. 108.5 (±14.0) (P<0.001). Five-year mortality was 7/57 (12.2%) in CRS patients compared to only 1/35 (2.9%) in patients without CRS (P=0.099). Univariate regression models showed a significant positive correlation between fractional shortening (FS) and eGFR (P= 0.0012, r2 = 0.09). No correlation was observed between eGFR and ejection fraction (EF), left ventricular end-diastolic dimension (LVEDD) and LVEDD Z-scores.Conclusion: This is the first study to show that CRS is common in children newly diagnosed with DCM and may be associated with higher five-year mortality rate. Worsening FS was associated with decreasing eGFR which suggests that patients with poor FS might have significant CRS. We suggest kidney function should be evaluated systematically in children with DCM to assess for chronic kidney disease and direct potential management.

Name thesis:degree_name

MS

Level thesis:degree_level

masters

Discipline thesis:degree_discipline

Medicine: Clinical and Translational Research

Grantor dc:publisher

University of Cincinnati

Year dc:date

2012

Author dc:creator

• Kaddourah, Ahmad, M.D.

Contributors dc:contributor

• Succop, Paul

• Surgery
• Cardioreal syndrome
• cardiomyopathy
• Chronic kidney disease

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=ucin1353949909

OAI identifier oai:identifier

oai:etd.ohiolink.edu:ucin1353949909