Fuhrman Dana Y, Schwartz George J, Cooper David S, Talisa Victor B, Hoskoppal Arvind K, Kellum John A
Department of Pediatrics, Division of Nephrology, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Suite 2000, Pittsburgh, PA, 15224, USA.
Program for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
Sci Rep. 2025 Jul 3;15(1):23690. doi: 10.1038/s41598-025-09461-6.
Due to advances in medical and surgical care, there are more adults than children living with congenital heart disease (CHD). Acute kidney injury (AKI) is a common complication following cardiac surgery in patients with CHD, with creatinine lacking sensitivity for early detection. Renal functional reserve (RFR), the kidney's capacity to increase filtration under stress, has emerged as a potential predictor of AKI. Our primary study objective was to evaluate whether preoperative RFR, using both creatinine clearance (CrCl) and cystatin C estimated glomerular filtration rate (eGFR) methods, predicts AKI following cardiopulmonary bypass in young adults with CHD. As a secondary objective, we compared RFR in CHD patients to that of healthy controls. This prospective cohort study included 30 young adults (ages 18-40) with acyanotic CHD and 8 healthy controls with normal baseline kidney function by serum creatinine. Preoperative RFR was measured using CrCl and cystatin C eGFR before and after a protein load. Postoperative AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria. Twelve (40%) CHD patients developed AKI, exhibiting significantly lower RFR when compared to those without AKI (median CrCl RFR: 9.6 vs. 35.0 mL/min/1.73m; cystatin C eGFR RFR: 5.5 vs. 11.5 mL/min/1.73m; P < 0.01). The ROC curve area for AKI prediction was 1.0 (CrCl RFR) and 0.88 (95% CI: 0.72-1.00, cystatin C eGFR RFR). CHD patients had lower RFR than controls (median CrCl: 25.5 vs. 56.4 mL/min/1.73m, P < 0.01; median cystatin C eGFR: 9.0 vs. 13.5 mL/min/1.73m, P = 0.03). In conclusion, preoperative RFR accurately predicts AKI in young adults with acyanotic CHD, providing a tool for the identification of high-risk patients and potentially improving perioperative care.
由于医学和外科治疗的进步，患有先天性心脏病（CHD）的成年人比儿童更多。急性肾损伤（AKI）是CHD患者心脏手术后常见的并发症，肌酐对早期检测缺乏敏感性。肾功储备（RFR），即肾脏在应激状态下增加滤过的能力，已成为AKI的一个潜在预测指标。我们的主要研究目的是评估术前使用肌酐清除率（CrCl）和胱抑素C估算肾小球滤过率（eGFR）方法的RFR是否能预测患有CHD的年轻成年人体外循环后的AKI。作为次要目的，我们比较了CHD患者与健康对照者的RFR。这项前瞻性队列研究纳入了30名患有非紫绀型CHD的年轻成年人（年龄18 - 40岁）和8名血清肌酐显示基线肾功能正常的健康对照者。术前在蛋白质负荷前后使用CrCl和胱抑素C eGFR测量RFR。术后AKI根据改善全球肾脏病预后组织的标准进行诊断。12名（40%）CHD患者发生了AKI，与未发生AKI的患者相比，其RFR显著更低（中位CrCl RFR：9.6 vs. 35.0 mL/min/1.73m；胱抑素C eGFR RFR：5.5 vs. 11.5 mL/min/1.73m；P < 0.01）。预测AKI的ROC曲线面积为1.0（CrCl RFR）和（95% CI：0.72 - 1.00，胱抑素C eGFR RFR）。CHD患者的RFR低于对照组（中位CrCl：25.5 vs. 56.4 mL/min/1.73m，P < 0.01；中位胱抑素C eGFR：9.0 vs. 13.5 mL/min/1.73m，P = 0.03）。总之，术前RFR能准确预测患有非紫绀型CHD的年轻成年人的AKI，为识别高危患者提供了一种工具，并可能改善围手术期护理。
