Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors

Abstract

Left ventricular hypertrophy (LVH) has been recognized as an independent risk factor for cardiovascular morbidity and mortality in adults with end-stage renal disease. However, the prevalence and severity of LVH in children on chronic dialysis therapy is not well established. Retrospectively, 64 chronic dialysis patients, aged 20 months to 22 years, on chronic dialysis had echocardiographic evaluation of LV mass (LVM) and geometry. Forty-eight (75%) children had LVH, including 22 of 26 (85%) on hemodialysis (HD) and 26 of 38 (68%) on peritoneal dialysis (PD). The prevalence of LVH in patients on HD was significantly higher than those on PD (P=0.02). Abnormal LV geometry was found in 51 of 64 (80%) patients: 25 patients (39%) had eccentric hypertrophy, 3 (5%) had concentric remodelling, and 23 (36%) had concentric LVH. Twenty-six children (41%) had severe LVH, defined as LVM index greater than 51 g/m2.7, which is associated with a fourfold greater risk for development of cardiovascular disease in adults. Patients with severe LVH had a significantly lower hemoglobin level (P=0.027) and longer duration of renal disease prior to the start of dialysis therapy (P=0.003) than patients without LVH. Multiple logistic regression analysis revealed HD as opposed to PD as a significant independent predictor for severe LVH (P=0.036). Higher systolic blood pressure remained in the final model as an independent predictor with a borderline level of significance (P=0.065). The results indicate that severe LVH and abnormal left ventricular geometry are common in young dialysis patients. Better control of blood pressure, anemia, and hypervolemia may be important in prevention or improving LVH.

Compromiso cardiovascular en pacientes pediátricos en diálisis peritoneal crónica

“…The International Pediatric Peritoneal Dialysis Network (IPPN) is based on these same recommendations. Values previously estimated by Mitsnefes with a more limited number of patients, found that LVMI was 68-73% in patients in PD 7 and 80-85% in patients in HD 7,16 . The collaborative study published by the IPPN found that the use of height-associated LVMI provides the most prevailing prevalence of LVH in patients with PD 8 .…”

“…Mitsnefes M. et al (10) reported a figure of 75%, and the IPPN registry showed that only 26% of PD patients had normal heart condition 8 . The NA-PRTCS 2008 Registry showed that, from 4,000 patients on dialysis, 57% were with uncontrolled hypertension (> 95%), confirming that in patients with PD, hypertension and cardiac damage are most frequently associated with LVH 7 .…”

“…The ANZDATA study reported that the mortality rate is 30 times higher than in pediatric patients without CKD 6 . Among the causes of mortality, cardiovascular disease corresponds to the 50% of the patients deaths on dialysis 7 .…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…Approximately 75-85% of adult and pediatric patients on hemodialysis have left ventricular hypertrophy (LVH) on echocardiography (736,737). LVH is associated with increased mortality on hemodialysis (736) and peritoneal dialysis (738).…”

“…Potentially reversible risk factors for LVH in hemodialysis patients include anemia hypertension and IHD (Table 61) (737,743,744). An approach to IHD has been outlined above.…”