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Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry

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Abstract

Background

The association of cardiorenal syndrome (CRS) with mortality in children with dilated cardiomyopathy (DCM) is unknown.

Methods

With a modified Schwartz formula, we estimated glomerular filtration rates (eGFR) for children ≥1 year of age with DCM enrolled in the Pediatric Cardiomyopathy Registry at the time of DCM diagnosis and annually thereafter. CRS was defined as an eGFR of <90 mL/min/1.73 m2. Children with and without CRS were compared on survival and serum creatinine concentrations (SCr). The association between eGFR and echocardiographic measures was assessed with linear mixed-effects regression models.

Results

Of 285 eligible children with DCM diagnosed at ≥1 year of age, 93 were evaluable. CRS was identified in 57 of these 93 children (61.3 %). Mean (standard deviation) eGFR was 62.0 (22.6) mL/min/1.73 m2 for children with CRS and 108.0 (14.0) for those without (P < 0.001); median SCr concentrations were 0.9 and 0.5 mg/dL, respectively (P < 0.001). The mortality hazard ratio of children with CRS versus those with no CRS was 2.4 (95 % confidence interval 0.8–7.4). eGFR was positively correlated with measures of left ventricular function and negatively correlated with age.

Conclusions

CRS in children newly diagnosed with DCM may be associated with higher 5-year mortality. Children with DCM, especially those with impaired left ventricular function, should be monitored for renal disease.

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Acknowledgments

We thank the participating centers for subject recruitment and follow-up data collection. We also thank the Children’s Cardiomyopathy Foundation for their ongoing support of the Pediatric Cardiomyopathy Registry’s research efforts. Finally, we thank Paul Succop, PhD for statistical advice.

Funding

This study was supported by NHLBI R01 HL53392 from the National Heart, Lung, and Blood Institute (NHLBI) and by the Children’s Cardiomyopathy Foundation (CCF). No NHLBI or CCF representatives were involved in the drafting of this manuscript. The contents of this work are solely the responsibility of the authors and do not necessarily represent the official views of the NHLBI or CCF.

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Correspondence to John L. Jefferies.

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Kaddourah, A., Goldstein, S.L., Lipshultz, S.E. et al. Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry. Pediatr Nephrol 30, 2177–2188 (2015). https://doi.org/10.1007/s00467-015-3165-8

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