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Severe cardiac hypertrophy and long-term dialysis: the Midwest Pediatric Nephrology Consortium study

Mark M Mitsnefes1, Gina M Barletta, Ian G Dresner

  • 1Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC: 7021, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA. mark.mitsnefes@cchmc.org

Pediatric Nephrology (Berlin, Germany)
|June 30, 2006
PubMed

Insights

Left ventricular hypertrophy (LVH) is common in children undergoing maintenance dialysis, persisting even after two years. This indicates a high risk for future cardiovascular disease in pediatric patients on dialysis.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Health in Children
  • Renal Replacement Therapy

Background:

  • Left ventricular hypertrophy (LVH) is a known complication in adult patients with chronic kidney disease.
  • Previous cross-sectional studies suggest LVH is prevalent in pediatric patients on maintenance dialysis.
  • Longitudinal data on LVH progression in children on dialysis is limited.

Purpose of the Study:

  • To assess the prevalence and severity of LVH in children undergoing maintenance dialysis over a two-year period.
  • To evaluate changes in left ventricular geometry during maintenance dialysis.
  • To identify potential factors contributing to LVH in this pediatric population.

Main Methods:

  • Retrospective analysis of echocardiogram data from 17 children across seven Midwest Pediatric Nephrology Consortium centers.
  • Patients had at least two years on maintenance dialysis and three echocardiograms: baseline, 1 year, and 2 years post-initiation.
  • Echocardiograms were analyzed for LVH prevalence, geometry (concentric vs. eccentric), and severity.

Main Results:

  • LVH was highly prevalent at dialysis initiation (82%) and remained frequent (82%) at two years.
  • Severe LVH was observed in 59% of patients after two years.
  • The prevalence of concentric LVH increased, while eccentric LVH remained unchanged, suggesting inadequate blood pressure and volume control.

Conclusions:

  • Children on maintenance dialysis exhibit persistent and often severe LVH.
  • Normalization of LV geometry is unlikely, highlighting challenges in managing these patients.
  • Pediatric patients on maintenance dialysis face a significant risk of future cardiovascular disease.

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