Relationship Between Central Venous Pressure, Cardiac Index, and Renal Function in Pediatric Heart Failure: a Pediatric Heart Transplant Society Study

Abstract

Renal dysfunction (RD) is common in patients with heart failure with or without congenital heart disease, but the determinants of renal dysfunction are not well understood in children with heart failure. Low cardiac output is often discussed as a risk factor for RD.The purpose of this study was therefore to elucidate the relationship between renal function and hemodynamic parameters in children with heart failure. Children (age < 18, n = 3739) listed for HT in the PHTS database from 1993-2023 were included. Laboratory, clinical, hemodynamic, and demographic parameters were collected and analyzed for the study. RD was defined as eGFR less than 40 ml/min/1.73 m2 for patients younger than 2 years old, less than 60 ml/min/1.73 m2 for patients 2 years old and older. We assessed correlation between eGFR and hemodynamic parameters. Logistic regression was used to assess risk factors for renal dysfunction by etiologic cohort. The mean age was 7.2 ± 6.2 years, weight 27.78 ± 25.03 kg, male gender 58%, 39% with cardiomyopathy (CM) and 61% with congenital heart disease (CHD) including 21% with Fontan circulation. RD was present in 6% of the cohort.In CM cohort, high BMI (OR 1.057, 1.025-1.091), male gender (OR 2.08, 1.21-3.59), black race (OR 1.98, 1.17-3.36) and heart failure category of high cardiac index with high CVP compared to high cardiac index with low CVP (OR 2.34, 1.27-4.29) were significant predictors of renal dysfunction.In Fontan cohort, only BMI (OR 1.08, CI 1.023-1.134) was associated with renal dysfunction while none of the hemodynamic parameters predicted RD in CHD cohort.Lastly, RD at listing (OR 2.82, CI 1.50-5.28), weight at transplant (OR 1.00, CI 1.00-1.01), post-transplant mechanical circulatory support (OR 2.55, CI 1.04-6.26), and post-transplant dialysis (2.74, CI 1.106.84) were associated with RD at one-year post-transplant for the overall cohort. The relationship between various clinical and hemodynamic factors and renal dysfunction is complex in children with heart failure. Further, the study continued to show persistent impact of renal dysfunction at listing on post-transplant renal function. Improving understanding modifiable risk factors by type of heart disease as well as role of newer heart failure therapies is critical in reducing this significant morbidity.

Keywords: Cardiorenal syndrome; Heart failure; Outcomes; Pediatric cardiology; Renal dysfunction; Venous congestion.