Compromiso cardiovascular en pacientes pediátricos en diálisis peritoneal crónica

Abstract

Peritoneal dialysis (PD) is the most common renal replacement therapy used in pediatric patients with end stage renal disease. This population has a mortality rate 1,000 times greater compare to pediatric population, mainly due to cardiovascular causes. Objective: To characterize pediatric patients on chronic PD in relation to dialysis and cardiovascular outcome. Patients and Methods: Cross sectional study. Patients in stable PD according to DOQI criteria were selected. Epidemiological, dialytic, biochemical and cardiovascular variables were registered. Left Ventricular Mass Index (LVMI) was calculated by height/age (g/m 2.7 ). Left Ventricular Hypertrophy (LVH) was diagnosed with > 38.6 g/m 2.7 , severe LVH > 51 g/m 2.7 . Data were analyzed using STATA 11.0. continuous variables using ANOVA test and categorical variables were analyzed using c 2 test or Fisher's exact test. Results: 21 patients, 11 males. Mean age 9.2 ± 3.52 years. The most frequent diagnosis was renal dysplasia (52%). Residual and Peritoneal KtV were 0.8 and 1.9 respectively. Fifty-two percent of patients showed LVH, 91% in severe range. A significant relationship between ultrafiltration/m2 and systolic blood pressure was depicted. Also a significant relationship between left ventricular mass index and hemoglobin (p < 0.05) was founded. Conclusions: The majority of the population showed left ventricular hypertrophy -particularly severe LVH-, which confirms an increased CV risk in this population. Blood pressure and loss of ultrafiltration were founded to be correlated to LVH.

Evaluación del Compromiso Cardiovascular en niños en diálisis mediante el Índice de Masa Ventricular Izquierdo

“…Ello nos permite plantearnos que un valor "x" de talla en un paciente de una edad de 7 años cronológica, sea leído en función de la edad corregida para la talla real del paciente enfermo renal crónico, que podría corresponder a un niño de "5" años. En nuestro estudio encontramos que un 56% de los casos cumple con el criterio de HVI similar a los descrito por Lehmman 24 , pero cuando se ajusta por la edad corregida por la talla la HVI disminuye a un 46,6%, al analizar el grado de concordancia de este resultado mediante escala de valoración kappa nos encontramos que el coeficiente tanto para MVI e IMVI inferior a nuestro punto de cohorte de 0,8, siendo posible concluir que sí existen diferencias en los rangos de percentiles de MVI e IMVI obtenidos al aplicar la corrección por edad corregida para la talla.…”

Free Water Transport and its Association with Cardiovascular Status in Children on Peritoneal Dialysis

“…In different studies, a high proportion of dialyzed children show cardiovascular damage (2,3,18,24–26). Left ventricular hypertrophy was found in 52% of 21 pediatric patients on chronic PD, corresponding to severe LVH in 91% of cases (27). We found a mean LVMI value of 42 ± 11.3 g/m 2.7 , slightly higher than that reported in other studies (24,28), but close to results published in large series of dialyzed children (4,7).…”