Diastolic function in children and adolescents on dialysis and after kidney transplantation: an echocardiographic assessment

Abstract

Thirty-seven children and adolescents on renal replacement therapy (11 on haemodialysis, 14 on continuous ambulatory peritoneal dialysis and 12 after renal transplantation) were studied by echocardiography, echo-Doppler and phonocardiography. Right and left ventricular (R/L V) diastolic functions were measured by transmitral and transtricuspid flow velocities and by LV isovolumic relaxation time (LVIRT). Thirty-seven age- and sex-matched healthy subjects served as controls. R/L V diastolic dysfunction was only observed in the dialysis patients. In these patients LVIRT was prolonged. LV and RV peak inflow velocities were increased both in early (E) and late (A) diastole with a reduction in the E/A ratios. This pattern of diastolic dysfunction is compatible with the combined effects of a hypercirculatory state (volume overload, anaemia, arteriovenous fistula) and an abnormality of cardiac relaxation. The transplant patients showed no major cardiac abnormalities.

Effects of whole blood viscosity and plasma NOx on cardiac function and cerebral blood flow in children with chronic kidney disease

“…The most widely used method to determine the diastolic functions of LV is Doppler examination of the mitral inflow velocity. These studies have shown that the LV relaxation (E/A) was impaired in children under dialysis (22,(33)(34)(35). Our Doppler findings were supported by the literature findings.…”

An Echocardiographic Assessment of Cardiac Functions and Structure in Children on Dialysis

“…[4,25] These reports suggested that CAPD has some advantages as a renal replacement therapy for preserving cardiac functions compared to HD in children. In our study, the peak A velocity was increased and E/A ratio was decreased in both CAPD and HD groups when compared to controls whereas there was no change in the peak E velocity among four groups.…”

“…Previous reports showed that together with decrease in E/A ratio, the prolongation in IVRT in dialysis patients compared to control group indicates an abnormal myocardial relaxation. [25] . Atalay et al [4] found that peak A velocity was significantly increased and IVRT was significantly prolonged in HD patients when compared with CAPD.…”

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

“…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).…”