Pediatric Cardiology

, Volume 34, Issue 1, pp 165–169 | Cite as

Renal Dysfunction is Common Among Adults After Palliation for Previous Tetralogy of Fallot

  • Matthew W. Buelow
  • Aaron Dall
  • Peter J. Bartz
  • James S. Tweddell
  • Jane Sowinski
  • Nancy Rudd
  • Lindsey Katzmark
  • Michael G. Earing
Original Article

Abstract

Long-term survival after tetralogy of Fallot (TOF) repair is excellent. However, little is published regarding late noncardiac complications. This study aimed to determine the prevalence and risk factors for renal dysfunction among adults after TOF repair. For this study, 56 adult patients with complete repair of TOF were identified, and their charts were retrospectively reviewed. An estimated glomerular filtration rate (eGFR) for each patient was calculated using the Modification of Diet in Renal Disease formula (MDRD). Using each patient’s eGFR, he or she was classified into stages based on the National Kidney Foundation chronic kidney disease (CKD) staging. Clinical parameters were compared among patients with and those without renal dysfunction to identify risk factors for renal impairment. The median estimated eGFR rate for the cohort was 78 ml/min/1.73 m2. Based on the National Kidney Foundation CKD staging system, 54 % of the patients had at least stage 2 chronic renal disease. The risk factors identified were hypertension (p < 0.01), type 2 diabetes mellitus (p < 0.05), longer follow-up evaluation (p < 0.005), older age at complete repair (p < 0.05), and use of daily diuretics (p < 0.05). After repair of TOF, renal dysfunction is common at late follow-up evaluation. The study findings show the importance of routine assessment of renal function and the need to limit or avoid future episodes of acute kidney injury in this at-risk population.

Keywords

Adult congenital heart disease Renal function Tetralogy of Fallot 

Notes

Acknowledgments

The authors gratefully acknowledge Mary Krolikowski for her support and guidance throughout this project. Funding was provided by the Medical College of Wisconsin.

Conflict of interest

No authors have any conflicts of interest to report.

References

  1. 1.
    Chawla LS, Amdur RL, Amodeo S et al (2011) The severity of acute kidney injury predicts progression to chronic kidney disease. Kidney Int 79:1361–1369PubMedCrossRefGoogle Scholar
  2. 2.
    Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41PubMedCrossRefGoogle Scholar
  3. 3.
    Coresh J, Selvin E, Stevens LA et al (2007) Prevalence of chronic kidney disease in the United States. J Am Med Assoc 17:2038–2047CrossRefGoogle Scholar
  4. 4.
    Dimopoulos K, Diller GP, Jiktsudam D et al (2008) Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease. Circulation 117:2320–2328PubMedCrossRefGoogle Scholar
  5. 5.
    Dittrich S, Kurschat K, Dahnert I et al (2000) Renal function after cardiopulmonary bypass surgery in cyanotic congenital heart disease. Int J Cardiol 73:173–179PubMedCrossRefGoogle Scholar
  6. 6.
    Levey AS, Bosch JP, Breyer Lewis J et al (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 330:877–884Google Scholar
  7. 7.
    Martinez-Quintana E, Rodriguez-Gonzalexz F, Fabregas-Brouard M, Nieto-Lago V (2009) Serum and 24-hour urine analysis in adult cyanotic and noncyanotic congenital heart disease patients. Congenit Heart Dis 4:147–152PubMedCrossRefGoogle Scholar
  8. 8.
    Muntner P, He J, Hamm L, Loria C, Whelton PK (2002) Renal insufficiency and subsequent death resulting from cardiovascular disease in the United States. J Am Soc Nephrol 13:745–753PubMedGoogle Scholar
  9. 9.
    National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 39:S1–S266CrossRefGoogle Scholar
  10. 10.
    Perloff JK, Latta H, Barsotti P (2000) Pathogenesis of the glomerular abnormality in cyanotic congenital heart disease. Am J Cardiol 86:1198–1204PubMedCrossRefGoogle Scholar
  11. 11.
    Pianosi PT, Johnson JN, Turchetta A, Johnson BD (2009) Pulmonary function and ventilatory limitation to exercise in congenital heart disease. Congenit Heart Dis 4:2–11PubMedCrossRefGoogle Scholar
  12. 12.
    Rastogi A, Fonarow GC (2008) The cardiorenal connection in heart failure. Curr Cardiol Rep 10:190–197PubMedCrossRefGoogle Scholar
  13. 13.
    Rosner MH, Okusa MD (2006) Acute kidney injury associated with cardiac surgery. Clin J Am Soc Nephrol 1:19–32PubMedCrossRefGoogle Scholar
  14. 14.
    Sarnak MJ, Levey AS, Schoolwerth AC et al (2003) Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 42:1050–1065PubMedCrossRefGoogle Scholar
  15. 15.
    Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263PubMedGoogle Scholar
  16. 16.
    Thakar CV, Christianson A, Himmelfarb J, Leonard AC (2011) Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol 6:2567–2572PubMedCrossRefGoogle Scholar
  17. 17.
    Tutarel O, Denecke A, Bode-Boger SM, Martens-Lobenhoffer J, Schieffer B, Westhoff-Bleck M, Kielstein JT (2011) Symmetrical dimethylarginine outperforms CKD-EPI and MDRD-derived eGFR for the assessment of renal function in patients with adult congenital heart disease. Kidney Blood Press Res 34:41–45PubMedCrossRefGoogle Scholar
  18. 18.
    Wu FM, Ukomadu C, Odze RD et al (2011) Liver disease in the patient with Fontan circulation. Congenit Heart Dis 6:190–201PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Matthew W. Buelow
    • 1
  • Aaron Dall
    • 2
  • Peter J. Bartz
    • 3
    • 5
  • James S. Tweddell
    • 4
  • Jane Sowinski
    • 3
  • Nancy Rudd
    • 3
  • Lindsey Katzmark
    • 3
  • Michael G. Earing
    • 3
    • 5
  1. 1.Department of PediatricsMedical College of WisconsinMilwaukeeUSA
  2. 2.Division of NephrologyMedical College of WisconsinMilwaukeeUSA
  3. 3.Division of Pediatric CardiologyMedical College of WisconsinMilwaukeeUSA
  4. 4.Division of Cardiovascular SurgeryMedical College of WisconsinMilwaukeeUSA
  5. 5.Division of Adult Cardiovascular MedicineMedical College of WisconsinMilwaukeeUSA

Personalised recommendations