Defining Left Ventricular Hypertrophy in Children on Peritoneal Dialysis

Abstract

SummaryBackground and objectives Left ventricular hypertrophy (LVH) is an important end point of dialysis-associated cardiovascular disease. The objective of this study was to evaluate the effect of different pediatric reference systems on the estimated prevalence of LVH in children on chronic peritoneal dialysis (CPD).Design, setting, participants, & measurements Echocardiographic studies in 507 pediatric CPD patients from neonatal age to 19 years were collected in 55 pediatric dialysis units around the globe. We compared the prevalence of LVH on the basis of the traditional cutoff of left ventricular mass (LVM) index (Ͼ38.5 g/m 2.7 ) with three novel definitions of LVH that were recently established in healthy pediatric cohorts.Results Application of the new reference systems eliminated the apparently increased prevalence of LVH in young children obtained by the traditional fixed LVM index cutoff currently still recommended by consensus guidelines. However, substantial differences of LVM distribution between the new reference charts resulted in a marked discrepancy in estimated LVH prevalence ranging between 27.4% and 51.7%.Conclusions Although our understanding of the anthropometric determinants of heart size during childhood is improving, more consistent normative echocardiographic data from large populations of healthy children are required for cardiovascular diagnostics and research.

Low agreement between cardiologists diagnosing left ventricular hypertrophy in children with end-stage renal disease

“…Yet, different indexations with respect to body size are used. All these different indexes for LVM lead to important differences in LVH prevalence, varying from 18% to 55% in children with chronic kidney disease [20] and from 27% to 52% in children on peritoneal dialysis [19]. In 2009 Khoury et al reported normal values for LVM indexed for height in children between 0 and 18 years of age [18].…”

“…As LVM indexed for weight or BSA had been found not to be accurate in children with obesity [27], it is conceivable that Khoury’s normal values are not applicable in growth-retarded (ESRD) children either. Borzych et al showed that when using the Khoury charts, LVH prevalence was significantly higher in growth-retarded children on peritoneal dialysis than in children on peritoneal dialysis of normal height [19]. Another approach to the definition of LVH is using z-scores of only the septal and/or posterior wall thickness as measure for LVH.…”

“…Various different methods of indexing LVM to body size have been reported, including adjustment for body surface area (BSA) [15] and height 2.7 [16,17]. The definition of LVH is a matter of ongoing controversy [17,18], especially in possibly growth-retarded children [19,20]. …”

Association between left ventricular mass index and cardiac function in pediatric dialysis patients

“…However, the ability of LVMI to quantify patient disease and predict cardiovascular outcomes is contingent on the definitions of normal ranges [27]. Given the controversy over appropriate cutoffs within pediatrics, we examined our data using three varying cutoff models and found significant differences among them.…”

Management of Anemia in Children Receiving Chronic Peritoneal Dialysis

“…In addition, results of echocardiography performed according to the guidelines of the American Society of Echocardiography are recorded optionally. 33,34 Data protection is ensured by pseudonymized data input. The registry protocol was approved by the ethical committees/institutional review boards as required at each participating center.…”