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Severe left ventricular hypertrophy in pediatric dialysis: prevalence and predictors
M M Mitsnefes1, S R Daniels, S M Schwartz
1Division of Nephrology and Hypertension, University of Cincinnati College of Medicine and The Children's Hospital Research Foundation, Ohio 45229-3039, USA. mitsm0@chmcc.org
Insights
Left ventricular hypertrophy (LVH) is common in children on chronic dialysis. Hemodialysis patients had higher LVH prevalence than peritoneal dialysis patients, indicating a need for better blood pressure and anemia control.
Area of Science:
- Pediatric Nephrology
- Cardiology
- Renal Disease Research
Background:
- Left ventricular hypertrophy (LVH) is a known risk factor for cardiovascular issues in adults with end-stage renal disease.
- The prevalence and severity of LVH in pediatric chronic dialysis patients remain poorly understood.
Purpose of the Study:
- To determine the prevalence and severity of LVH in children undergoing chronic dialysis.
- To identify risk factors associated with LVH in this population.
Main Methods:
- Retrospective analysis of echocardiographic data from 64 pediatric chronic dialysis patients (20 months to 22 years).
- Evaluation of left ventricular mass (LVM) and geometry.
- Comparison of LVH prevalence between hemodialysis (HD) and peritoneal dialysis (PD) groups.
Main Results:
- 75% of children had LVH; prevalence was significantly higher in HD (85%) vs. PD (68%) patients (P=0.02).
- 80% exhibited abnormal LV geometry (eccentric hypertrophy, concentric remodeling, or concentric LVH).
- Severe LVH (LVM index > 51 g/m2.7) was present in 41% and associated with lower hemoglobin and longer renal disease duration.
Conclusions:
- Severe LVH and abnormal left ventricular geometry are prevalent in pediatric dialysis patients.
- Hemodialysis is an independent predictor of severe LVH.
- Controlling blood pressure, anemia, and hypervolemia may be crucial for LVH prevention and management in these young patients.
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.