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Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease.
Olsen, Jillian; Tunuguntla, Hari; Alali, Alexander; Choudhry, Swati; Hope, Kyle D; Puri, Kriti; Spinner, Joseph A; Akcan-Arikan, Ayse; Price, Jack F.
Afiliação
  • Olsen J; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Tunuguntla H; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Alali A; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Choudhry S; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Hope KD; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Puri K; Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Spinner JA; Department of Pediatrics, Division of Cardiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Akcan-Arikan A; Department of Pediatrics, Division of Critical Care Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA.
  • Price JF; Division of Critical Care Medicine.
JACC Adv ; 3(7): 100995, 2024 Jul.
Article em En | MEDLINE | ID: mdl-39129999
ABSTRACT

Background:

Traditionally, low cardiac output has been considered the primary hemodynamic driver of renal function and injury. Adult data suggest that central venous pressure (CVP) is a more important factor.

Objectives:

The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF).

Methods:

We performed a single-center cohort study of patients aged 3 months to 21 years with biventricular circulation undergoing cardiac catheterization. Pearson's correlation and linear and Cox regression analyses were performed to determine associations with eGFR at the time of catheterization and WFR within 180 days after catheterization.

Results:

312 patients had median age 7.9 years (IQR 2.3 to 14.5 years), median eGFR 97 mL/min/1.73 m2 (IQR 81-118 mL/min/1.73 m2), median CVP 7 mm Hg (IQR 5-9 mm Hg), and median cardiac index 3.7 mL/min/m2 (IQR 2.9-4.6 mL/min/m2). Nearly half (48%) were transplant recipients. In multivariable analysis, CVP was independently associated with eGFR (ß = -2.65; 95% CI -4.02, -1.28; P < 0.001), as was being a transplant recipient (ß = -10.20; 95% CI -17.74, -2.65; P = 0.008), while cardiac index was not. Fifty-one patients (16%) developed WRF. In a proportional hazards model adjusting for cardiac index, only higher CVP (HR 1.10; 95% CI 1.04-1.17; P = 0.002) and greater contrast volume by weight (HR 1.05; 95% CI 1.01-1.10; P = 0.021) predicted WRF. CVP ≥7 mm Hg likewise predicted WRF (HR 2.57; 95% CI 1.29-5.12; P = 0.007).

Conclusions:

Among children with a spectrum of cardiovascular disease, higher CVP is associated with lower eGFR and development of WRF, independent of cardiac index.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Ano de publicação: 2024 Tipo de documento: Article