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Pediatr Nephrol. 2017 Aug;32(8):1401-1410. doi: 10.1007/s00467-017-3622-7. Epub 2017 Mar 8.

Longitudinal assessment of myocardial function in childhood chronic kidney disease, during dialysis, and following kidney transplantation.

Author information

1
Institute of Medical Science, and the Cardiovascular Sciences Collaborative Program, University of Toronto, Toronto, ON, Canada.
2
Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
3
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
4
Division of Nephrology, Department of Pediatrics, McMaster Children's Hospital-McMaster University, Hamilton, ON, Canada.
5
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
6
Division of Nephrology, The Hospital for Sick Children-University of Toronto, Toronto, ON, Canada.
7
Department of Pediatrics, Hospital for Sick Children and Medicine, University Health Network-University of Toronto, Toronto, ON, Canada.
8
Division of Cardiology, Labatt Family Heart Center, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. luc.mertens@sickkids.ca.
9
Department of Pediatrics, Hospital for Sick Children and Medicine, University Health Network-University of Toronto, Toronto, ON, Canada. luc.mertens@sickkids.ca.
10
Department of Pediatrics, Children's Hospital, London Health Sciences Centre , University of Western Ontario, London, ON, Canada.

Abstract

BACKGROUND:

Childhood chronic kidney disease (CKD) and dialysis are associated with increased long-term cardiovascular risk. We examined subclinical alterations in myocardial mechanics longitudinally in children with CKD, during dialysis, and following renal transplantation.

METHODS:

Forty-eight children with CKD (stage III or higher) who received kidney transplants from 2008 to 2014 were included in a retrospective study and compared to 192 age- and sex-matched healthy children. Measurements of cardiac systolic and diastolic function were performed, and global longitudinal strain (GLS) and circumferential strain (GCS) were measured by speckle-tracking echocardiography at CKD, during dialysis, and 1 year following kidney transplantation. Mixed-effects modeling examined changes in GLS and GCS over different disease stages.

RESULTS:

Children with CKD had a mean age of 10 ± 5 years and 67% were male. Eighteen children received preemptive transplantation. Children with CKD had increased left ventricular mass, lower GLS, and impaired diastolic function (lower E/A ratio and E' velocities) than healthy children. Changes in left ventricular diastolic parameters persisted during dialysis and after renal transplantation. Dialysis was associated with reduced GLS compared to CKD (β = 1.6, 95% confidence interval 0.2-3.0); however, this was not significant after adjustment for systolic blood pressure and CKD duration. Post-transplantation GLS levels were similar to those at CKD assessment. GCS was unchanged during dialysis but significantly improved following transplantation.

CONCLUSIONS:

There are differences in diastolic parameters in childhood CKD that persist during dialysis and after transplantation. Systolic parameters are preserved, with significant improvement in systolic myocardial deformation following transplantation. The impact of persistent diastolic changes on long-term outcomes requires further investigation.

KEYWORDS:

Children; Chronic kidney disease; Dialysis; Kidney transplant; Myocardial mechanics; Systolic strain

PMID:
28275864
DOI:
10.1007/s00467-017-3622-7
[Indexed for MEDLINE]

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