title: Prevalence, predictors, and outcomes of cardiorenal syndrome in children with dilated cardiomyopathy: a report from the Pediatric Cardiomyopathy Registry.
abstract: BACKGROUND
  The association of cardiorenal syndrome (CRS) with mortality in children with dilated cardiomyopathy (DCM) is unknown.
  
  
  METHODS
  With a modified Schwartz formula, we estimated glomerular filtration rates (eGFR) for children ≥1 year of age with DCM enrolled in the Pediatric Cardiomyopathy Registry at the time of DCM diagnosis and annually thereafter. CRS was defined as an eGFR of <90 mL/min/1.73 m(2). Children with and without CRS were compared on survival and serum creatinine concentrations (SCr). The association between eGFR and echocardiographic measures was assessed with linear mixed-effects regression models.
  
  
  RESULTS
  Of 285 eligible children with DCM diagnosed at ≥1 year of age, 93 were evaluable. CRS was identified in 57 of these 93 children (61.3%). Mean (standard deviation) eGFR was 62.0 (22.6) mL/min/1.73 m(2) for children with CRS and 108.0 (14.0) for those without (P < 0.001); median SCr concentrations were 0.9 and 0.5 mg/dL, respectively (P < 0.001). The mortality hazard ratio of children with CRS versus those with no CRS was 2.4 (95% confidence interval 0.8-7.4). eGFR was positively correlated with measures of left ventricular function and negatively correlated with age.
  
  
  CONCLUSIONS
  CRS in children newly diagnosed with DCM may be associated with higher 5-year mortality. Children with DCM, especially those with impaired left ventricular function, should be monitored for renal disease.
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kaddourah
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML 2003, Cincinnati, OH, 45229, USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI, USA.|University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.affiliation: Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, MI, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
authors.affiliation: New England Research Institutes, Watertown, MA, USA.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Sleeper
authors.affiliation: New England Research Institutes, Watertown, MA, USA.
authors.forename: Minmin
authors.initials: M
authors.lastname: Lu
authors.affiliation: Boston Children's Hospital, Boston, MA, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.affiliation: The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML 2003, Cincinnati, OH, 45229, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
authors.affiliation: Montefiore Medical Center, New York City, NY, USA.
authors.forename: Scott I
authors.initials: SI
authors.lastname: Aydin
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Rossano
authors.affiliation: Primary Children's Hospital, Salt Lake City, UT, USA.
authors.forename: Melanie D
authors.initials: MD
authors.lastname: Everitt
authors.affiliation: Anne & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Gossett
authors.affiliation: University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Paolo
authors.initials: P
authors.lastname: Rusconi
authors.affiliation: Stollery Children's Hospital, Edmonton, Alberta, Canada.
authors.forename: Paul F
authors.initials: PF
authors.lastname: Kantor
authors.affiliation: Columbia University Medical Center, New York City, NY, USA.
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Singh
authors.affiliation: Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. john.jefferies@cchmc.org.|The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML 2003, Cincinnati, OH, 45229, USA. john.jefferies@cchmc.org.
authors.forename: John L
authors.initials: JL
authors.lastname: Jefferies
mesh_terms: D000293:Adolescent; D059347:Cardio-Renal Syndrome / Q000453:epidemiology* / Q000209:etiology*; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008297:Male; D015995:Prevalence; D012042:Registries; D015996:Survival Rate
keywords: Cardiomyopathy; Cardiorenal syndrome; Chronic kidney disease; Heart failure; Pediatrics