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ASSESSMENT OF PREVALENCE OF KIDNEY DYSFUNCTION IN THE ADULT FONTAN POPULATION
S272 METHODS/RESULTS:
Eligible participants included 104 patients (133 years) who participated in the Pediatric Heart Network Fontan 2 Follow-up Study at the Hospital for Sick Children. Participants completed psychosocial questionnaires, cardiopulmonary exercise testing, and physical activity assessments during the Fontan 2 Follow-up Study. Participants (N¼32; 213 years, 50% male) from this cohort were recruited to complete a 7-day physical activity re-assessment using tri-axial accelerometers. The most recent cardiopulmonary exercise testing results were also extracted from medical record review. Paired t-test analysis was used to determine changes between study periods for MVPA and exercise capacity. Univariable and multivariable linear regression analysis was used to determine factors associated with MVPA as a young adult. Mean MVPA decreased by 12min/day between study periods (mean standard deviation)(3928 MVPA min/day vs. 2717 MVPA min/ day; p¼0.01). Exercise capacity (VO2peak) was unchanged between study periods (286 ml/kg/min vs. 288 ml/kg/ min; p¼0.97). Univariable regression analysis demonstrated a significant positive association between adult MVPA and higher childhood VO2peak (parameter estimate[standard error]; p-value) (+1.4[0.7]; p¼0.04) and higher childhood daily MVPA (+0.40[0.14]; p¼0.004). Adult MVPA showed a modest positive association with higher adult VO2peak (+0.88[0.46]; p¼0.06). Multivariable regression analysis demonstrated that higher adult MVPA was associated with higher adult VO2peak (+2.2[0.8]; p¼0.01) while adult MVPA was not associated with childhood VO2peak or childhood MVPA (-0.83[1.20]; p¼0.50 and +0.25[0.20]; p¼0.24, respectively). CONCLUSION: This study identified reduced daily MVPA and unchanged exercise capacity among patients with Fontan circulation from childhood to early adulthood. Regular physical activity should be encouraged among Fontan patients throughout their clinical care. Additional exercise recommendations among young adults with Fontan circulation may also aim to increase exercise capacity (VO2peak) in response to cardiovascular and physiological changes experienced in adulthood. Future research should explore underlying psychosocial and physiological factors associated with physical activity among the emerging adult Fontan population. 516 ASSESSMENT OF PREVALENCE OF KIDNEY DYSFUNCTION IN THE ADULT FONTAN POPULATION D Lee, J Grewal Vancouver, British Columbia
Canadian Journal of Cardiology Volume 31 2015 BACKGROUND: Chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (uACR), predicts adverse events in the general cardiac population. However, the true prevalence of CKD, using both uACR and eGFR measurements, has not been identified in the Fontan population and may help to explain poor outcomes. Approximately 10-15% of adult Fontan patients have moderate to severe kidney dysfunction based on eGFR alone and it is associated with 5 fold increase in mortality. Assessment of uACR may further identify Fontan patients with CKD. Additionally, the accuracy of standard equations used to calculate eGFR in the general population, such as CKD-EPI, have not been validated in this population. Our objectives are to determine the prevalence of CKD as determined by uACR and eGFR and to determine the accuracy of eGFR compared to measured GFR in the adult Fontan population. METHODS: We conducted a prospective study including adult patients who had a Fontan operation and are actively followed in our Pacific Adult Congenital Hospital at University of British Columbia. Seventy-two patients were included. Serum creatinine and uACR were collected. Estimated GFR was calculated using the CKD-EPI equation. CKD prevalence was ascertained by the stringent criteria set forth by the Kidney Disease: Improving Global Outcomes guidance 2012. GFR was measured in a subgroup of patients by determining clearance of 99 Tc-DTPA. RESULTS: Fifty of 72 consecutive patients were included. The prevalence of any degree of albuminuria was 78% (n¼39/50). Significant albuminuria ( > 3mg/mmol in both urine collections) was present in 30% (n¼15/50) of all enrolled patients. The mean uACR was 2.3+1.9 mg/mmol (median 1.8 mg/mmol and range 0.4 to 7.6 mg/mmol) among the 39 patients with any degree of albuminuria. The eGFR in the overall population was 99+22 ml/min/1.73m2 with no eGFR below 60 ml/min/1.73m2. In the uACR > 3mg/mmol vs. < 3 mg/mmol the eGFR was 102+20 ml/min/1.73m2 vs. 98+3 ml/min/1.73m2, p¼0.65. Upwards of 30% of adult Fontan patients have sub-clinical CKD with significant albuminuria with a normal eGFR and hence are not identified. CONCLUSION: Our pilot data suggests that the uACR is able to identify Fontan patients with CKD more readily than using eGFR alone. Validation of eGFR using CKD-EPI equation is currently under investigation by our group. Our next step will be to propose a multicenter Canadian prospective observational cohort study to assess the burden of CKD in this population.
Eligible participants included 104 patients (133 years) who participated in the Pediatric Heart Network Fontan 2 Follow-up Study at the Hospital for Sick Children. Participants completed psychosocial questionnaires, cardiopulmonary exercise testing, and physical activity assessments during the Fontan 2 Follow-up Study. Participants (N¼32; 213 years, 50% male) from this cohort were recruited to complete a 7-day physical activity re-assessment using tri-axial accelerometers. The most recent cardiopulmonary exercise testing results were also extracted from medical record review. Paired t-test analysis was used to determine changes between study periods for MVPA and exercise capacity. Univariable and multivariable linear regression analysis was used to determine factors associated with MVPA as a young adult. Mean MVPA decreased by 12min/day between study periods (mean standard deviation)(3928 MVPA min/day vs. 2717 MVPA min/ day; p¼0.01). Exercise capacity (VO2peak) was unchanged between study periods (286 ml/kg/min vs. 288 ml/kg/ min; p¼0.97). Univariable regression analysis demonstrated a significant positive association between adult MVPA and higher childhood VO2peak (parameter estimate[standard error]; p-value) (+1.4[0.7]; p¼0.04) and higher childhood daily MVPA (+0.40[0.14]; p¼0.004). Adult MVPA showed a modest positive association with higher adult VO2peak (+0.88[0.46]; p¼0.06). Multivariable regression analysis demonstrated that higher adult MVPA was associated with higher adult VO2peak (+2.2[0.8]; p¼0.01) while adult MVPA was not associated with childhood VO2peak or childhood MVPA (-0.83[1.20]; p¼0.50 and +0.25[0.20]; p¼0.24, respectively). CONCLUSION: This study identified reduced daily MVPA and unchanged exercise capacity among patients with Fontan circulation from childhood to early adulthood. Regular physical activity should be encouraged among Fontan patients throughout their clinical care. Additional exercise recommendations among young adults with Fontan circulation may also aim to increase exercise capacity (VO2peak) in response to cardiovascular and physiological changes experienced in adulthood. Future research should explore underlying psychosocial and physiological factors associated with physical activity among the emerging adult Fontan population. 516 ASSESSMENT OF PREVALENCE OF KIDNEY DYSFUNCTION IN THE ADULT FONTAN POPULATION D Lee, J Grewal Vancouver, British Columbia
Canadian Journal of Cardiology Volume 31 2015 BACKGROUND: Chronic kidney disease (CKD), as determined by estimated glomerular filtration rate (eGFR) and urine albumin to creatinine ratio (uACR), predicts adverse events in the general cardiac population. However, the true prevalence of CKD, using both uACR and eGFR measurements, has not been identified in the Fontan population and may help to explain poor outcomes. Approximately 10-15% of adult Fontan patients have moderate to severe kidney dysfunction based on eGFR alone and it is associated with 5 fold increase in mortality. Assessment of uACR may further identify Fontan patients with CKD. Additionally, the accuracy of standard equations used to calculate eGFR in the general population, such as CKD-EPI, have not been validated in this population. Our objectives are to determine the prevalence of CKD as determined by uACR and eGFR and to determine the accuracy of eGFR compared to measured GFR in the adult Fontan population. METHODS: We conducted a prospective study including adult patients who had a Fontan operation and are actively followed in our Pacific Adult Congenital Hospital at University of British Columbia. Seventy-two patients were included. Serum creatinine and uACR were collected. Estimated GFR was calculated using the CKD-EPI equation. CKD prevalence was ascertained by the stringent criteria set forth by the Kidney Disease: Improving Global Outcomes guidance 2012. GFR was measured in a subgroup of patients by determining clearance of 99 Tc-DTPA. RESULTS: Fifty of 72 consecutive patients were included. The prevalence of any degree of albuminuria was 78% (n¼39/50). Significant albuminuria ( > 3mg/mmol in both urine collections) was present in 30% (n¼15/50) of all enrolled patients. The mean uACR was 2.3+1.9 mg/mmol (median 1.8 mg/mmol and range 0.4 to 7.6 mg/mmol) among the 39 patients with any degree of albuminuria. The eGFR in the overall population was 99+22 ml/min/1.73m2 with no eGFR below 60 ml/min/1.73m2. In the uACR > 3mg/mmol vs. < 3 mg/mmol the eGFR was 102+20 ml/min/1.73m2 vs. 98+3 ml/min/1.73m2, p¼0.65. Upwards of 30% of adult Fontan patients have sub-clinical CKD with significant albuminuria with a normal eGFR and hence are not identified. CONCLUSION: Our pilot data suggests that the uACR is able to identify Fontan patients with CKD more readily than using eGFR alone. Validation of eGFR using CKD-EPI equation is currently under investigation by our group. Our next step will be to propose a multicenter Canadian prospective observational cohort study to assess the burden of CKD in this population.