CHICAGO — More than a third of adults with congenital heart disease also had significant renal dysfunction in a review of 201 patients, Dr. Sanaz Piran said at the annual scientific sessions of the American Heart Association.
Impaired renal function in patients with congenital heart disease was also linked with worse ventricular function and a dramatically increased risk of death, she added.
The analysis that she reported was done on 201 consecutive patients older than 18 years with single or systemic right ventricles seen at the Toronto Congenital Cardiac Centre for Adults. The group included 73 patients with detransposition of the great arteries (DTGA), 69 who had a Fontan procedure, and 59 with congenitally corrected transposition of the great arteries (CCTGA). Their average age was 34 years. The analysis also included 30 normal, healthy, age-matched controls.
The overall prevalence of renal dysfunction—defined as a calculated creatinine clearance rate of less than 60 mL/min—was 36%, with prevalence rates of 56% in patients who had a Fontan procedure, 37% in those who had CCTGA, and 18% in patients following DTGA.
The ventricular ejection fraction was also significantly lower (37%) in patients with a creatinine clearance rate of less than 60 mL/min, compared with patients with a creatinine clearance of 60 mL/min or greater, who had an average ejection fraction of 44%. During follow-up of up to 30 years, 22 patients died. The mortality was 24% among the patients with renal dysfunction at baseline, compared with a 2% death rate among those with a creatinine clearance rate of more than 60 mL/min at baseline, said Dr. Piran, a physician at McMaster University in Hamilton, Ont.