Buelow Matthew W, Dall Aaron, Bartz Peter J, Tweddell James S, Sowinski Jane, Rudd Nancy, Katzmark Lindsey, Earing Michael G
Department of Pediatrics, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA.
Pediatr Cardiol. 2013 Jan;34(1):165-9. doi: 10.1007/s00246-012-0408-3. Epub 2012 Jun 7.
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 m(2). 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.
法洛四联症(TOF)修复术后的长期生存率很高。然而,关于晚期非心脏并发症的报道却很少。本研究旨在确定TOF修复术后成人肾功能不全的患病率及危险因素。在本研究中,确定了56例TOF完全修复的成年患者,并对其病历进行回顾性分析。使用肾脏病饮食改良公式(MDRD)计算每位患者的估计肾小球滤过率(eGFR)。根据美国国立肾脏基金会慢性肾脏病(CKD)分期标准,依据每位患者的eGFR进行分期。比较肾功能正常和肾功能不全患者的临床参数,以确定肾功能损害的危险因素。该队列的估计eGFR中位数为78 ml/min/1.73 m²。根据美国国立肾脏基金会CKD分期系统,54%的患者至少患有2期慢性肾脏病。确定的危险因素包括高血压(p < 0.01)、2型糖尿病(p < 0.05)、随访评估时间较长(p < 0.005)、完全修复时年龄较大(p < 0.05)以及使用每日利尿剂(p < 0.05)。TOF修复术后,晚期随访评估时肾功能不全很常见。研究结果表明,对该高危人群进行肾功能常规评估很重要,并需要限制或避免未来发生急性肾损伤。