Abstract Body (Do not enter title and authors here): Introduction/Background
Cardiovascular-kidney-metabolic (CKM) syndrome is the interplay between metabolic risk factors such as obesity and diabetes, chronic kidney disease (CKD), and cardiovascular disease (CVD). Youth with congenital heart disease (CHD) can have increased baseline CVD risk due to structural heart disease and associated procedures, but data on CKM syndrome in this group are limited. Presence of CKM syndrome with CHD could further increase cardiac risk in these youth.

Research Questions/Hypothesis
Estimate prevalence of CKM syndrome in youth with hypertension disorders who have CHD and estimate its association with target organ injury (TOI).

Methods/Approach
A cross-sectional analysis was performed on baseline data from 7 sites in the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective registry of electronic health record data. Data were acquired using standardized biomedical informatics scripts and validated by randomly selected manual record review. Inclusion criteria were youth <19 years old with CHD who received subspecialty care for hypertension disorders from 1/1/2016–12/31/2023 defined by ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. We estimated CKM syndrome stage prevalence and used directed acyclic graph-informed multivariable generalized linear models to evaluate the association between CKM stages 0-2 and risk of TOI by ICD-10 codes.

Results/Data
There were 9356 participants (Table 1: 38% female, mean age 12.8 years [SD 4.5]). There were 212 participants (2%) with CHD—10% having CKM Stage 0, 16% CKM Stage 1, and 66% CKM Stage 2. There was no difference in CKM syndrome prevalence between youth with CHD and those without CHD. TOI was seen in 8% of youth with CHD; however, CKM syndrome was not found to be associated with TOI (Table 2).

Conclusion(s)
Nearly two-thirds of youth with hypertension disorders and CHD had CKM Stage 2. However, there was no difference in CKM syndrome prevalence between those with CHD versus those without CHD, and there was no association between CKM syndrome and TOI in those with CHD. Ongoing steps are to improve accuracy and validity of CHD, CKM, and TOI definitions within SUPERHERO by validating with medical and surgical histories to better assess potential risk in these patients.