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Echocardiographic evaluation in children treated with CAPD
N Aksu1, O Yavascan, H Erdogan
1Department of Pediatric Nephrology, SSK Tepecik Teaching Hospital, Yenisehir, Izmir, Turkey.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) may impact cardiac function in children. Studies show systolic and diastolic dysfunctions tend to progress over time in pediatric patients on CAPD.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Medical Imaging
Background:
- End-stage renal disease (ESRD) in children requires renal replacement therapy.
- Continuous ambulatory peritoneal dialysis (CAPD) is a common treatment modality for pediatric ESRD.
- Cardiac function can be affected by chronic illness and its treatments.
Purpose of the Study:
- To assess systolic and diastolic cardiac functions in children undergoing CAPD.
- To compare cardiac function in CAPD patients with healthy controls.
- To evaluate changes in cardiac function over a 1-year follow-up period in CAPD patients.
Main Methods:
- Echocardiography (2D, M-mode, color Doppler) was used to measure systolic (EF, FS) and diastolic (E, A, E/A ratio, EF slope, dt) parameters.
- Interventricular septum thickness and blood pressure (BP) were monitored.
- Statistical analysis included Student's t-test for comparisons.
Main Results:
- Pediatric CAPD patients exhibited significantly impaired systolic and diastolic cardiac function compared to controls (P < 0.05).
- Mean BP levels were comparable between CAPD patients and controls.
- Cardiac function showed a trend towards deterioration over 1 year in a subset of patients, though not statistically significant (P > 0.05).
Conclusions:
- CAPD is a preferred treatment for pediatric ESRD, helping maintain stable cardiac function initially.
- Progressive systolic and diastolic cardiac dysfunction is a concern in children on long-term CAPD.
- Further research is needed to optimize cardiac care for pediatric CAPD patients.
Abstract:
The aim of this study was to evaluate systolic and diastolic cardiac functions in children treated with continuous ambulatory peritoneal dialysis (CAPD). This study included a total of 21 patients (12 boys, 9 girls), aged 23 months to 14 years (average age: 10.1 +/- 4.32 years). The mean duration on CAPD was 12.88 +/- 6.69 months (range: 2-22 months). Twenty age- and sex-matched healthy subjects served as controls. Evaluation was made at the beginning of CAPD treatment in these 21 patients. Tests were repeated in 9 of 21 patients who had completed a 1-year follow-up period. We measured systolic functions [ejection fraction (EF), and fractional shortening (FS)], and diastolic functions [early (E) and late (A) diastolic peak inflow velocities, and E/A ratio, as well as early diastolic flow deceleration velocity (EF slope) and time (dt) functions] using two-dimensional, M-mode, color Doppler echocardiography. Interventricular septum thickness was also recorded. Blood pressure (BP) levels were monitored serially in all patients. Statistical evaluation was made using Student's t-test. Compared with control subjects, systolic and diastolic parameters were significantly inversely affected in patients on CAPD (P < 0.05). The mean BP levels did not differ significantly between CAPD patients and controls. In 9 patients with a second measurement on CAPD, systolic and diastolic cardiac functions tended to have deteriorated. However, these changes were not statistically significant (P > 0.05). In conclusion, CAPD is the preferable option in children with end-stage renal disease to maintain stable cardiac functions. However, systolic and diastolic dysfunctions tend to progress in children on CAPD.