Dataset Information

Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease.

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 (β = -2.65; 95% CI: -4.02, -1.28; P < 0.001), as was being a transplant recipient (β = -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.

SUBMITTER: Olsen J

PROVIDER: S-EPMC11312305 | biostudies-literature | 2024 Jul

REPOSITORIES: biostudies-literature

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Publications

Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease.

Olsen Jillian J Tunuguntla Hari H Alali Alexander A Choudhry Swati S Hope Kyle D KD Puri Kriti K Spinner Joseph A JA Akcan-Arikan Ayse A Price Jack F JF

JACC. Advances 20240521 7

<h4>Background</h4>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.<h4>Objectives</h4>The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF).<h4>Methods</h4>We performed a single-center cohort study of patients aged 3 months to 21 ...[more]

PMID: 39129999

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Project description:Background and objectiveIncreased renal venous pressure (RVP) is common in combined heart and kidney failure. We previously showed that acute RVP elevation depresses renal blood flow (RBF), glomerular filtration rate (GFR), and induces renal vasoconstriction in the absence of changes in blood pressure in healthy rats. We used our established rodent model of chronic combined heart and kidney failure (H/KF) to test whether RVP elevation would impair cardiovascular stability, renal perfusion and exacerbate renal dysfunction.MethodsMale rats were subjected to 5/6 nephrectomy (SNx or Sham) and 6% high salt diet followed 7 weeks later by ligation of the left anterior descending coronary artery (CL or Sham). Experimental groups: CL + SNx (n = 12), Sham CL + SNx (n = 9), CL+ Sham SNx (n = 6), and Sham Control (n = 6). Six weeks later, anesthetized rats were subjected to an acute experiment whereupon mean arterial pressure (MAP), heart rate (HR), RVP, RBF, and GFR were measured at baseline and during elevation of RVP to 20-25 mmHg for 120 min.ResultsBaseline MAP, HR, RBF, and renal vascular conductance (RVC) were comparable among groups. Baseline GFR was significantly depressed in CL + SNx and Sham CL + SNx groups compared to Sham Control and CL + Sham SNx groups. Upon RVP increase, MAP and HR fell in all groups. Increased RVP exacerbated the reduction in RBF in CL + SNx (-6.4 ± 0.9 ml/min) compared to Sham Control (-3.7 ± 0.9 ml/min, p < 0.05) with intermediate responses in Sham CL + SNx (-6.8 ± 1.3 ml/min) and CL + Sham SNx (-5.1 ± 0.4 ml/min) groups. RVP increase virtually eliminated GFR in CL + SNx (-99 ± 1%), Sham CL + SNx (-95 ± 5%), and CL + Sham SNx (-100%) groups compared to Sham Control (-84 ± 15% from baseline; p < 0.05). Renal vascular conductance dropped significantly upon RVP increase in rats with HF (CL + SNx: -0.035 ± 0.011; CL + Sham SNx: -0.050 ± 0.005 ml/min·mmHg-1, p < 0.05) but not Sham CL + SNx (-0.001 ± 0.019 ml/min·mmHg-1) or Control (-0.033 ± mL/min·mmHg-1).ConclusionChronic combined heart and kidney failure primarily impairs renal hemodynamic stability in response to elevated RVP compared to healthy rats.

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Dataset Information

Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease.

Background

Objectives

Methods

Results

Conclusions

Publications

Central Venous Pressure and Impaired Renal Function in Children and Young Adults With Cardiovascular Disease.

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