ESPN 54th Annual Meeting

ESPN 2022


 
Fontan associated nephropathy: does diastolic function play a role?
NICOLA BERTAZZA PARTIGIANI 1 ROBERTA BIFFANTI 2 JOLANDA SABATINO 2 GERMANA LONGO 1 ELISA BENETTI 1 MATTIA PAROLIN 1 MARTA ROTELLA 2 BEATRICE BINDA 4 MASSIMO PADALINO 3 DAVIDE MENEGHESSO 1

1- PEDIATRIC NEPHROLOGY AND DIALYSIS UNIT, DEPARTMENT OF WOMEN’S AND CHILD’S HEALTH, UNIVERSITY OF PADOVA MEDICAL SCHOOL, 35128 PADOVA, ITALY
2- PAEDIATRIC CARDIOLOGY, DEPARTMENT OF WOMEN’S AND CHILD’S HEALTH, UNIVERSITY OF PADOVA MEDICAL SCHOOL, 35128 PADOVA, ITALY
3- PEDIATRIC AND CONGENITAL CARDIAC SURGERY UNIT, DEPARTMENT OF CARDIAC, THORACIC AND VASCULAR SCIENCES AND PUBLIC HEALTH, UNIVERSITY OF PADOVA MEDICAL SCHOOL, 35128 PADOVA, ITALY
4- University of Padova Medical School, 35128 Padova, Italy
 
Introduction:

We investigate the long term nephrological outcomes, the physiopathology of kidney involvement and its relationship with cardiac diastolic function in Fontan patients.

Material and methods:

This is a prospective study including patients who underwent Fontan completion in our Centre between 1993 and 2016. We excluded patients with major congenital renal anomalies, those who underwent cardiac transplantation and redo-Fontan patients. Patients underwent clinical evaluation, laboratory exams with renal function, kidney US and complete cardiac evaluation.

Results:

We enrolled 35 patients, 46% female (N=16), and 54% male (N= 19). Medium age was 17 y.o., (range 10-31 y.o.). Medium time from Fontan completion was 160 months (range 57-340 months). Ten patients had a functional single left ventricle (FSLV, 28,5%) and 21 a functional single right ventricle (FSRV, 60%); 4 patients had an undetermined single ventricle (11,5%). Data from renal function assessment showed 26% of patients with stage 2 CKD (eGFR 60-89 ml/min/1,73mq) and only one with stage 3 CKD, using cystatin C based equation. Most of the patients with CKD were FSRV (89%). Erased beta-2-microglobulin levels were present in 4 patients. Echocardiographic evaluation of diastolic function showed 2 patients with baseline E/A < 1 (6%, tot N=33) and 11/33 (33%) pts with abnormal E/E’ (>12). A statistical relationship between diastolic parameters (E/E’) and tubular damage is found (Pearson’s R 0,4 and 0,48, respectively, p<0,05). Diastolic function appeared to be associated also with glomerular filtration, with direct correlation between diastolic pulmonary wave deceleration time and creatinine value (Pearson’s R 0,49, p<0,05). 

 

Conclusions:

Fontan related nephropathy is associated with worsening diastolic function, which was more represented in FSRV patients. Those data suggest renal function should be closely monitored in patients with impaired diastolic function.