Left ventricular abnormalities in children, adolescents and young adults with renal disease

Abstract

The cardiac abnormalities that complicate chronic renal failure and renal replacement therapy are not well characterized in young people. These abnormalities are becoming more important because successful renal transplantation has resulted in children with end-stage renal failure living longer. Echocardiographic abnormalities of cardiac function and structure were studied in children and young adults (< 27 years old) with chronic renal failure (CRF, N = 32), end-stage renal failure treated with chronic peritoneal dialysis (CPD, N = 10) or renal transplantation (N = 30) or controls (N = 60). Left ventricular mass indexed for height (LVM/Ht and LVM/Ht2.7) and body surface area (LVM/SA), fractional shortening, measurement of left ventricular diastolic function (peak E and A wave velocities and the EA ratio) and structural (such as valvular) abnormalities were determined by echocardiography. The median (and range) of LVM/Ht in the groups were control 51.8 (23.1 to 119.8), CRF 60.2 (22.2 to 135.8), CPD 80.2 (14.5 to 100.9) and transplant group 97.8 (51.2 to 182.1) g/m. The increases in LVM/Ht, LVM/Ht2.7 and LVM/SA in the transplant group were significant (P < 0.01). The CRF group had significantly increased LVM/Ht2.7 and LVM/SA (P < 0.01). Systolic function was not significantly different between the groups. A significant correlation between creatinine and LVM indexed for height was found in the CRF group. Systolic or diastolic blood pressure could not be correlated with LVM indices in the transplant group. Changes in diastolic function were found (increased peak A wave velocity and decreased E/A ratios in the CRF and CPD groups, and increased peak E wave velocity in the transplant group). The study demonstrated that left ventricular hypertrophy is a frequent and often severe finding in children with chronic renal failure and those treated with renal replacement therapy. Factors other than hypertension and anaemia are important, and evidence was found for a link between serum creatinine and increased left ventricular mass prior to end-stage renal failure.

BP Control and Left Ventricular Hypertrophy Regression in Children with CKD

“…[1][2][3][4][5]16 Previous cross-sectional analysis in the CKiD cohort (n=366) reported a 17% prevalence of LVH at baseline. 2 Our present longitudinal study, in a larger population (n=478), showed similar prevalence of LVH at baseline (V2) of 16%.…”

“…[1][2][3][4][5] Some data in children with CKD suggest that the development of LVH is associated with other cardiac abnormalities, such as impaired systolic function. [6][7][8][9] Thus, understanding the factors that contribute to LVH in children with CKD may lead to interventions to reduce future cardiovascular risk.…”

Left Ventricular Mass and Systolic Performance in Pediatric Patients With Chronic Renal Failure

“…3 In contrast, systolic LV function is thought to be preserved in children with chronic renal failure. 1,4,5 However, these studies have examined LV systolic performance at rest, and it is possible that evaluation during exercise may unmask more subtle changes in LV function.…”

“…Echocardiographic studies show that young patients with chronic renal insufficiency (CRI) and end-stage renal disease have abnormalities of both left ventricular (LV) structure and function. [1][2][3][4][5] Children with chronic renal disease have a high prevalence of left ventricular hypertrophy (LVH). 1,6 -10 In adults with hypertension and chronic renal failure, LVH is thought to be initially adaptive to improve contractility and lower wall stress (WS) in the face of increased afterload (blood pressure) and preload (volume).…”

Unusual Pattern of Dyslipidemia in Children Receiving Steroid Minimization Immunosuppression after Renal Transplantation

“…The need to recognize and investigate dyslipidemia after transplantation is related to the well known observation that even in children, cardiovascular diseases are responsible for over 40% of all mortality in the setting of ESRD (26). Although the risk of cardiovascular mortality decreases significantly after transplantation, it continues to account for about 10% of all deaths in the post-transplant period (27).…”