Left-ventricular diastolic dysfunction in Korean children with chronic kidney disease: data from the KNOW-Ped CKD study

Abstract

Background Cardiovascular disease (CVD) is the most common cause of mortality in pediatric chronic kidney disease (CKD) patients. Left ventricular (LV) hypertrophy (LVH) is associated with LV diastolic dysfunction (LVDD) development and is used as an early marker of CVD in pediatric CKD. This study aimed to assess the prevalence and risk factors of LVDD and the association between LVH and LVDD in Korean pediatric CKD patients. Methods Data were collected using the baseline data of the Korean cohort study for outcome in patients with pediatric chronic kidney disease, a nationwide, 10-year, prospective, observational cohort study of pediatric CKD. A total of 244 patients were included in the final analysis. Two-dimensional echocardiography and tissue Doppler images were used to evaluate LVH and LVDD. LVH was defined as an LV mass index (LVMI) ≥38 g/m2.7 and LV-wall thickness z-score > 1.64. LVDD was defined as a mitral peak velocity of early filling to early diastolic mitral annular velocity (E/E’) > 14. Univariate and multivariate logistic regression analyses were performed to evaluate risk factors of LVDD. Results In this study, the male-to-female ratio was 2.2 (168:76) and median age was 11.2 years. The average estimated glomerular filtration rate was 57.4 ml/min/1.73 m2, and no patients received renal replacement therapy. The mean value of LVMI and E/E’ was 37.0 g/m2.7 and 7.4, respectively. The prevalence of LVH was 40.1 and 17.4% by LVMI ≥38 g/m2.7 and LV-wall thickness z-score, respectively. The prevalence of LVDD was 4.5%, and patients with LVH showed greater risk of LVDD (odds ratio 7.3, p = 0.012). In the univariate analysis, young age, low hemoglobin level, higher LVMI, and higher LV-wall thickness z-score were associated with LVDD. In the multivariate analysis, young age, low hemoglobin level, and higher LV-wall thickness z-score were independently associated with LVDD. Conclusion This study shows that LVH patients have a greater risk of LVDD and that anemia is the only modifiable risk factor for LVDD in Korean pediatric CKD patients.

Association of Left Ventricular Diastolic Dysfunction With Cardiovascular Outcomes in Patients With Pre-dialysis Chronic Kidney Disease: Findings From KNOW-CKD Study

“…Second, as the formal definition of LVDD requires additional echocardiographic measures other than E/e ′ (19), the definition of LVDD in this study (i.e., E/e ′ > 14) is a simplified and modified one. Nevertheless, E/e ′ is a feasible and reproducible index to assess the LV filling pressure (19,33) and has been used to evaluate LVDD in the other cohort studies (9,34,35). Third, due to the operational definition of LVDD in this study, the grade of LVDD was not assessed.…”

Risk Factors for the Progression of Chronic Kidney Disease in Children

“…Anemia is a common complication of CKD and is asso ciated with several clinical consequences, including mor tality, cardiovascular morbidity, and growth failure 40,41) . Two prospective cohort studies for children with CKD showed that 40%-45% of patients had anemia and the he moglobin level decreases as GFR declines 42,43) .…”