PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF).
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Among children with a spectrum of cardiovascular disease, higher CVP is associated with lower eGFR and development of WRF, independent of cardiac index.
UNASSIGNED: The authors hypothesized that in children with cardiovascular disease, higher CVP predicts lower estimated glomerular filtration rate (eGFR) and worsening renal function (WRF).
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: Among children with a spectrum of cardiovascular disease, higher CVP is associated with lower eGFR and development of WRF, independent of cardiac index.
摘要：
■传统上，低心输出量已被认为是肾功能和损伤的主要血液动力学驱动因素。成人数据表明，中心静脉压（CVP）是更重要的因素。
■作者假设在患有心血管疾病的儿童中，较高的CVP预示较低的估计肾小球滤过率(eGFR)和恶化的肾功能(WRF).
■我们对3个月至21岁的双心室循环患者进行了一项单中心队列研究。进行Pearson相关性以及线性和Cox回归分析，以确定导管插入时eGFR和导管插入后180天内WFR的相关性。
■312名患者的中位年龄为7.9岁（IQR：2.3至14.5岁），eGFR中位数97毫升/分钟/1.73平方米（IQR：81-118毫升/分钟/1.73平方米），中位数CVP7mmHg（IQR：5-9mmHg），和中位数心脏指数3.7mL/min/m2（IQR：2.9-4.6mL/min/m2）。将近一半（48％）是移植接受者。在多变量分析中，CVP与eGFR独立相关(β=-2.65;95%CI:-4.02,-1.28;P<0.001),作为移植受者（β=-10.20；95％CI：-17.74，-2.65；P=0.008），而心脏指数没有。51名患者（16％）发生WRF。在调整心脏指数的比例风险模型中，只有更高的CVP(HR:1.10;95%CI:1.04-1.17;P=0.002)和更大的重量对比剂体积(HR:1.05;95%CI:1.01-1.10;P=0.021)预测WRF。CVP≥7mmHg同样可预测WRF（HR：2.57；95%CI：1.29-5.12；P=0.007）。
■在患有一系列心血管疾病的儿童中，较高的CVP与较低的eGFR和WRF的发展有关，与心脏指数无关。
■作者假设在患有心血管疾病的儿童中，较高的CVP预示较低的估计肾小球滤过率(eGFR)和恶化的肾功能(WRF).
■我们对3个月至21岁的双心室循环患者进行了一项单中心队列研究。进行Pearson相关性以及线性和Cox回归分析，以确定导管插入时eGFR和导管插入后180天内WFR的相关性。
■312名患者的中位年龄为7.9岁（IQR：2.3至14.5岁），eGFR中位数97毫升/分钟/1.73平方米（IQR：81-118毫升/分钟/1.73平方米），中位数CVP7mmHg（IQR：5-9mmHg），和中位数心脏指数3.7mL/min/m2（IQR：2.9-4.6mL/min/m2）。将近一半（48％）是移植接受者。在多变量分析中，CVP与eGFR独立相关(β=-2.65;95%CI:-4.02,-1.28;P<0.001),作为移植受者（β=-10.20；95％CI：-17.74，-2.65；P=0.008），而心脏指数没有。51名患者（16％）发生WRF。在调整心脏指数的比例风险模型中，只有更高的CVP(HR:1.10;95%CI:1.04-1.17;P=0.002)和更大的重量对比剂体积(HR:1.05;95%CI:1.01-1.10;P=0.021)预测WRF。CVP≥7mmHg同样可预测WRF（HR：2.57；95%CI：1.29-5.12；P=0.007）。
■在患有一系列心血管疾病的儿童中，较高的CVP与较低的eGFR和WRF的发展有关，与心脏指数无关。
