Cardiorenal Syndrome in Adults with Congenital Heart Disease
Cardiorenal Syndrome in Adults with Congenital Heart Disease
Journal: Journal of Clinical Medicine (MDPI) – Published 20 June 2025
Key Insights:
1. Population Studied:
Adults with congenital heart disease (ACHD) featuring:
• Systemic right ventricle (e.g. d-TGA, ccTGA)
• Subpulmonary right ventricle (e.g. TOF, Eisenmenger)
• Fontan circulation
2. Prevalence of Renal Dysfunction:
• 30–50% of ACHD patients have reduced eGFR (<90 mL/min/1.73 m²)
• Up to 9–10% display moderate–severe CKD (<60 mL/min) 
3. Pathophysiology:
• Chronic hemodynamic stress: low cardiac output, high central venous pressure
• Neurohormonal activation
• Repeated surgeries and hypoxemia contribute to renal injury 
4. Biomarkers for Early Detection:
• Albuminuria, cystatin C, and eGFR are vital for monitoring CRS
• NT-proBNP correlates with cardiac and renal function decline 
5. Management Strategies:
• Early detection and tailored heart failure therapy
• Volume control, neurohormonal blockade (ACEi/ARBs), diuretics
• Consideration for transplant evaluation when end-organ damage is irreversible 
6. Significance:
• Highlights a frequently under‑recognized CRS subtype
• Offers a call for cardiologists and nephrologists to adopt multidisciplinary approaches in ACHD care
Conclusion:
Cardiorenal syndrome in ACHD is common and driven by unique hemodynamic factors. Early biomarker-based detection and tailored, collaborative management are key to improving outcomes in this growing patient group.