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Cardiovascular disease in pediatric chronic dialysis patients
Blanche M Chavers1, Shuling Li, Allan J Collins
1Department of Pediatrics, University of Minnesota, United States Renal Data System, and Cardiovascular Special Studies Center, Minneapolis, Minnesota, USA.
Insights
Cardiovascular disease is a major concern for children on chronic dialysis, with over 31% experiencing cardiac events. Black, female, and adolescent children face higher risks, and cardiomyopathy is on the rise.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Medicine
- Public Health
Background:
- Limited data exists on cardiac issues in pediatric end-stage renal disease patients.
- This study addresses the incidence of cardiac morbidity and mortality in pediatric chronic dialysis patients.
Purpose of the Study:
- To determine the incidence of cardiac morbidity and mortality in children undergoing chronic dialysis.
- To identify risk factors associated with cardiovascular disease in this population.
Main Methods:
- Utilized Medicare data from pediatric dialysis patients (ages 0-19) from 1991-1996.
- Analyzed endpoints including arrhythmia, valvular heart disease, cardiomyopathy, cardiac arrest, all-cause mortality, and cardiac-related death.
- Employed Poisson regression and chi-square tests for statistical analysis.
Main Results:
- 1454 children were included; 31.1% experienced a cardiac event.
- Arrhythmia (19.6%) was most common, followed by valvular disease (11.7%) and cardiomyopathy (9.6%).
- Increased incidence of arrhythmia and valvular disease observed in adolescents, females, and Black children. Cardiomyopathy incidence rose between 1991-1996.
Conclusions:
- Cardiovascular disease poses a significant threat to pediatric chronic dialysis patients.
- Cardiomyopathy incidence is increasing in this cohort.
- Black, female, and adolescent children are at elevated risk for cardiovascular disease.
Background:
Little information is available regarding cardiac morbidity and mortality in children with end-stage renal disease. We sought to determine the incidence of cardiac morbidity and mortality in pediatric chronic dialysis patients.
Methods:
Medicare incident pediatric (0 to 19 years) dialysis patients from 1991 to 1996 were identified from the United States Renal Data System. Study endpoints included development of arrhythmia, valvular heart disease, cardiomyopathy, or cardiac arrest, all causes of death, and cardiac-related death. Statistical analyses were performed using the Poisson regression model and chi-square test.
Results:
A total of 1454 children were eligible for inclusion, 452 (31.1%) of whom developed a cardiac-related event. Arrhythmia was the most common event (19.6%) compared with valvular disease (11.7%), cardiomyopathy (9.6%), and cardiac arrest (3%). Arrhythmia and valvular heart disease incidence were increased in 15- to 19-year-olds (P < 0.0001 for both), females (P = 0.004, P = 0.03) and blacks (P < 0.0001, P = 0.002). Cardiomyopathy incidence was increased in blacks (P = 0.001) and tended to be increased in females (P = 0.053). The adjusted annual cardiomyopathy rate during the first 3 years increased between 1991 and 1996 (P = 0.003). Death occurred in 107 patients, and 41 (38%) were cardiac deaths.
Conclusions:
Cardiovascular disease is a significant cause of morbidity and mortality in pediatric chronic dialysis patients. Cardiomyopathy incidence is increasing. Black, female, and adolescent children have increased risk for cardiovascular disease.
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