Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease
Abstract Due to advances in medical and surgical care, there are more adults than children living with congenital heart disease (CHD). Acute kidney injury (AKI) is a common complication following cardiac surgery in patients with CHD, with creatinine lacking sensitivity for early detection. Renal fun...
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Nature Portfolio
2025-07-01
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| Online Access: | https://doi.org/10.1038/s41598-025-09461-6 |
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| author | Dana Y. Fuhrman George J. Schwartz David S. Cooper Victor B. Talisa Arvind K. Hoskoppal John A. Kellum |
| author_facet | Dana Y. Fuhrman George J. Schwartz David S. Cooper Victor B. Talisa Arvind K. Hoskoppal John A. Kellum |
| author_sort | Dana Y. Fuhrman |
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| description | Abstract Due to advances in medical and surgical care, there are more adults than children living with congenital heart disease (CHD). Acute kidney injury (AKI) is a common complication following cardiac surgery in patients with CHD, with creatinine lacking sensitivity for early detection. Renal functional reserve (RFR), the kidney’s capacity to increase filtration under stress, has emerged as a potential predictor of AKI. Our primary study objective was to evaluate whether preoperative RFR, using both creatinine clearance (CrCl) and cystatin C estimated glomerular filtration rate (eGFR) methods, predicts AKI following cardiopulmonary bypass in young adults with CHD. As a secondary objective, we compared RFR in CHD patients to that of healthy controls. This prospective cohort study included 30 young adults (ages 18–40) with acyanotic CHD and 8 healthy controls with normal baseline kidney function by serum creatinine. Preoperative RFR was measured using CrCl and cystatin C eGFR before and after a protein load. Postoperative AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria. Twelve (40%) CHD patients developed AKI, exhibiting significantly lower RFR when compared to those without AKI (median CrCl RFR: 9.6 vs. 35.0 mL/min/1.73m2; cystatin C eGFR RFR: 5.5 vs. 11.5 mL/min/1.73m2; P < 0.01). The ROC curve area for AKI prediction was 1.0 (CrCl RFR) and 0.88 (95% CI: 0.72–1.00, cystatin C eGFR RFR). CHD patients had lower RFR than controls (median CrCl: 25.5 vs. 56.4 mL/min/1.73m2, P < 0.01; median cystatin C eGFR: 9.0 vs. 13.5 mL/min/1.73m2, P = 0.03). In conclusion, preoperative RFR accurately predicts AKI in young adults with acyanotic CHD, providing a tool for the identification of high-risk patients and potentially improving perioperative care. |
| format | Article |
| id | doaj-art-69788bc54dfa4d11a3d47b25b728ef54 |
| institution | DOAJ |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-69788bc54dfa4d11a3d47b25b728ef542025-08-20T03:03:36ZengNature PortfolioScientific Reports2045-23222025-07-0115111010.1038/s41598-025-09461-6Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart diseaseDana Y. Fuhrman0George J. Schwartz1David S. Cooper2Victor B. Talisa3Arvind K. Hoskoppal4John A. Kellum5Department of Pediatrics, Division of Nephrology, UPMC Children’s Hospital of PittsburghDepartment of Pediatrics, Division of Pediatric Nephrology, University of Rochester Medical CenterDepartment of Pediatrics, The Heart Institute, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of MedicineDepartment of Critical Care Medicine, School of Medicine, University of PittsburghDepartment of Pediatrics, Division of Pediatric Cardiology, UPMC Children’s Hospital of PittsburghProgram for Critical Care Nephrology, Department of Critical Care Medicine, University of PittsburghAbstract Due to advances in medical and surgical care, there are more adults than children living with congenital heart disease (CHD). Acute kidney injury (AKI) is a common complication following cardiac surgery in patients with CHD, with creatinine lacking sensitivity for early detection. Renal functional reserve (RFR), the kidney’s capacity to increase filtration under stress, has emerged as a potential predictor of AKI. Our primary study objective was to evaluate whether preoperative RFR, using both creatinine clearance (CrCl) and cystatin C estimated glomerular filtration rate (eGFR) methods, predicts AKI following cardiopulmonary bypass in young adults with CHD. As a secondary objective, we compared RFR in CHD patients to that of healthy controls. This prospective cohort study included 30 young adults (ages 18–40) with acyanotic CHD and 8 healthy controls with normal baseline kidney function by serum creatinine. Preoperative RFR was measured using CrCl and cystatin C eGFR before and after a protein load. Postoperative AKI was diagnosed using the Kidney Disease Improving Global Outcomes criteria. Twelve (40%) CHD patients developed AKI, exhibiting significantly lower RFR when compared to those without AKI (median CrCl RFR: 9.6 vs. 35.0 mL/min/1.73m2; cystatin C eGFR RFR: 5.5 vs. 11.5 mL/min/1.73m2; P < 0.01). The ROC curve area for AKI prediction was 1.0 (CrCl RFR) and 0.88 (95% CI: 0.72–1.00, cystatin C eGFR RFR). CHD patients had lower RFR than controls (median CrCl: 25.5 vs. 56.4 mL/min/1.73m2, P < 0.01; median cystatin C eGFR: 9.0 vs. 13.5 mL/min/1.73m2, P = 0.03). In conclusion, preoperative RFR accurately predicts AKI in young adults with acyanotic CHD, providing a tool for the identification of high-risk patients and potentially improving perioperative care.https://doi.org/10.1038/s41598-025-09461-6Renal functional reserveAcute kidney injuryCongenital heart diseaseStress GFR |
| spellingShingle | Dana Y. Fuhrman George J. Schwartz David S. Cooper Victor B. Talisa Arvind K. Hoskoppal John A. Kellum Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease Scientific Reports Renal functional reserve Acute kidney injury Congenital heart disease Stress GFR |
| title | Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| title_full | Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| title_fullStr | Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| title_full_unstemmed | Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| title_short | Preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| title_sort | preoperative renal functional reserve as a predictor of acute kidney injury in young adults with congenital heart disease |
| topic | Renal functional reserve Acute kidney injury Congenital heart disease Stress GFR |
| url | https://doi.org/10.1038/s41598-025-09461-6 |
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